A Case of Idiopathic Colonic Varices: A Rare Cause of Hematochezia

Introduction: Colonic varices, typically associated with portal hypertension, are a rare cause of lower gastrointestinal bleeding, with idiopathic colonic varices being exceedingly uncommon. Case Presentation: We report a case of a 36-year-old male who presented with acute abdominal pain, hematochezia (blood-streaked stools), and severe iron deficiency anemia. The patient’s past medical history was unremarkable, with no known liver disease, alcohol use, or family history of gastrointestinal disorders. Esophagogastroduodenoscopy (EGD) and colonoscopy revealed dilated varices in the colon, though no active bleeding was observed. Comprehensive laboratory investigations, including liver function tests, coagulation profiles, and viral hepatitis serologies, were within normal limits. Imaging studies, including contrast-enhanced computed tomography (CT) of the abdomen and Doppler ultrasonography, ruled out portal hypertension and other systemic pathologies. With no identifiable underlying cause, a diagnosis of idiopathic colonic varices was made. Treatment and Outcome: The patient was managed conservatively with packed red blood cell transfusions and oral iron supplementation to correct the anemia. A follow-up colonoscopy at three months showed no progression of varices, and the patient remained asymptomatic. Conclusion: This case highlights the importance of considering idiopathic colonic varices in patients with hematochezia and iron deficiency anemia, even in the absence of portal hypertension. A thorough diagnostic workup, including endoscopy and imaging, is essential to exclude more common causes and arrive at this rare diagnosis.