CT evaluation of pararectal varices

Area of Science:

• Radiology
• Gastroenterology
• Vascular Medicine

Background:

• Portal hypertension leads to the formation of varices, which can occur in various locations.
• Pararectal varices are a potential complication, and their detection may have clinical significance.

Purpose of the Study:

• To determine the prevalence of pararectal varices on CT scans in patients with portal hypertension.
• To assess the correlation between pararectal varices on CT, inferior mesenteric vein (IMV) diameter, and the presence of rectal varices on colonoscopy.

Main Methods:

• Retrospective review of 83 CT scans of the abdomen and pelvis in patients with portal hypertension.
• Assessment of pararectal variceal size and prevalence on CT.
• Correlation with colonoscopic and endoscopic findings.
• Comparison of IMV diameter in patients with and without pararectal varices.

Main Results:

• Twenty patients (24%) showed CT evidence of pararectal varices (mean diameter 7.8 mm).
• The IMV was significantly larger in patients with pararectal varices (mean 7.5 mm) compared to those without (mean 5.8 mm) (p=0.014).
• No significant correlation was found between pararectal varices on CT and rectal varices on colonoscopy, nor between IMV diameter and rectal varices.

Conclusions:

• Including the pelvis in CT scans of portal hypertension patients provides additional information on pararectal venous collaterals.
• CT-detected pararectal varices and IMV diameter do not correlate with colonoscopically identified rectal varices.
• The presence of rectal and pararectal varices does not appear to reduce the incidence of esophageal varices.