Clinical Study Comparing Bleeding and Nonbleeding Rectal Varices

 

 Buy Article Permissions and Reprints

Background and Study Aims: Although rectal varices constitute an important cause of lower digestive tract bleeding in patients with portal hypertension, the etiology and pathology of rectal varices remains controversial, and adequate treatment for rectal varices has yet to be established. In this study, we evaluated rectal varices to identify any common characteristics of varices which are susceptible to hemorrhage.Patients and Methods: The patients included 40 individuals with rectal varices among 425 patients with portal hypertension who had been treated in our institution. We retrospectively examined patient data regarding underlying hepatic diseases, hepatic function and endoscopic findings with regard to varices.

Results: Bleeding from rectal varices occurred in 15 of the 40 patients. Although the prevalence of hemorrhage tended to increase with exacerbation of hepatic dysfunction, no significant differences were found. Similarly, although the incidence of hemorrhage tended to be somewhat higher in patients who had undergone any treatment for complicated esophageal varices than in patients who had not, no significant difference was found. The prevalence of hemorrhage from rectal varices significantly increased in rectal varices of more advanced form, and the prevalence was significantly higher in patients with positive “red color” sign.

Conclusions: The prevalence of hemorrhage from rectal varices was significantly higher in patients with rectal varices of advanced form and/or with a positive “red color” sign.

References

• 1 Lebrec D, Benhamou J P. Ectopic varices in portal hypertension.  Clin Gastroenterol. 1985;  14 105-121
  PubMedGoogle Scholar
• 2 Weiserbs D B, Zfass A M, Messmer J. Control of massive hemorrhage from rectal varices with sclerotherapy.  Gastrointest Endosc. 1986;  32 419-421
  PubMedGoogle Scholar
• 3 Hosking S W, Smart H L, Johnson A G. et al . Anorectal varices, haemorrhoids, and portal hypertension.  Lancet. 1989;  18 349-352
  PubMedGoogle Scholar
• 4 McCormack T T, Bailey H R, Simms J M. et al . Rectal varices are not piles.  Br J Surg. 1984;  71 163
  CrossrefPubMedGoogle Scholar
• 5 Herman B E, Baum S, Denobile J. et al . Massive bleeding from rectal varices.  Am J Gastroenterol. 1993;  88 939-942
  PubMedGoogle Scholar
• 6 Waxman J S, Tarkin N, Dave P. et al . Fatal hemorrhage from rectal varices: report of two cases.  Dis Colon Rectum. 1984;  27 749-750
  CrossrefPubMedGoogle Scholar
• 7 Ishigami Y, Masuzawa M, Miyoshi E. et al . Clinical application of ICG finger monitor in patients with liver disease.  J Hepatol. 1993;  19 232-240
  CrossrefPubMedGoogle Scholar
• 8 Idezuki Y. and Japanese Research Society for Portal Hypertension . General rules for recording endoscopic findings of esophageal varices (1991).  World J Surg. 1995;  19 420-423
  CrossrefPubMedGoogle Scholar
• 9 Beppu K, Inokuchi K, Koyanagi N. et al . Prediction of variceal hemorrhage by esophageal endoscopy.  Gastrointest Endosc. 1981;  27 213-218
  PubMedGoogle Scholar
• 10 Wang T F, Lee F Y, Tsai Y T. et al . Relationship of portal pressure, anorectal varices and hemorrhoids in cirrhotic patients.  J Hepatol. 1992;  15 170-173
  CrossrefPubMedGoogle Scholar
• 11 Chawla Y K, Dilawari J B. Anorectal varices -their frequency in cirrhotic and non-cirrhotic portal hypertension.  Gut. 1991;  32 309-311
  CrossrefPubMedGoogle Scholar
• 12 Kinkhabwala M, Mousavi A, Iyer S. et al . Bleeding ileal varicosity demonstrated by transhepatic portography.  Am J Roentgenol. 1977;  129 514-516
  PubMedGoogle Scholar
• 13 Britton R C. Influence of portal systemic patterns and distribution of varices on results of surgical treatment of bleeding esophageal varices.  Surgery. 1963;  53 567-574
  PubMedGoogle Scholar
• 14 Johansen K, Bardin J, Orloff M J. Massive bleeding from hemorrhoidal varices in portal hypertension.  JAMA. 1980;  244 2084-2085
  CrossrefPubMedGoogle Scholar
• 15 Wilson S E, Stone R T, Christie J P. et al . Massive lower gastrointestinal bleeding from intestinal varices.  Arch Surg. 1979;  114 1158-1161
  PubMedGoogle Scholar
• 16 Richon J, Berclaz R, Schneider P A. et al . Sclerotherapy of rectal varices.  Colorect Dis. 1988;  3 132-134
  PubMedGoogle Scholar
• 17 Thomson W HF. The nature of haemorrhoids.  Br J Surg. 1975;  62 542-552
  CrossrefPubMedGoogle Scholar
• 18 Inokuchi K,. and Cooperative Study Group on Portal Hypertension in Japan . Improved survival after prophylactic portal non-decompression surgery for esophageal varices: a randomized clinical trial.  Hepatology. 1990;  12 1-6
  PubMedGoogle Scholar
• 19 The Italian Liver Cirrhosis Project. Reliability of endoscopy in the assessment of variceal features.  J Hepatol. 1987;  4 93-98
  CrossrefPubMedGoogle Scholar

R. Shudo, M.D., F.A.C.P., F.A.C.G.

Digestive Disease Center · Kobayashi Hospital

West 4 Street · North 3 Avenue · Kitami · Hokkaido 090-8567 · Japan

Fax: + 81-157-618071

Email: brucelee@abelia.ocn.ne.jp