Anorectal varices - Misplaced Pages

(Redirected from Rectal varices) Not to be confused with Haemorrhoid.Dilated veins in the anus Medical condition

Anorectal varices
Specialty	Gastroenterology, Hematology
Symptoms	Coffee ground vomiting, Hematochezia
Complications	Internal bleeding, hypovolemic shock, cardiac arrest
Causes	Portal hypertension
Treatment	Treating portal hypertension, surgery (transjugular intrahepatic portosystemic shunt)

Anorectal varices are collateral submucosal blood vessels dilated by backflow in the veins of the rectum. Typically this occurs due to portal hypertension which shunts venous blood from the portal system through the portosystemic anastomosis present at this site into the systemic venous system. This can also occur in the esophagus, causing esophageal varices, and at the level of the umbilicus, causing caput medusae. Between 44% and 78% of patients with portal hypertension get anorectal varices.

Signs and symptoms

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Pathogenesis

Blood from the superior portion of the rectum normally drains into the superior rectal vein and via the inferior mesenteric vein to the liver as part of the portal venous system. Blood from the middle and inferior portions of the rectum is drained via the middle and inferior rectal veins. In portal hypertension, venous resistance is increased within the portal venous system; when the pressure in the portal venous system increases above that of the systemic, blood is shunted through the portosystemic anastomoses. The shunting of blood and consequential increase of pressure through the collateral veins causes the varicosities.

Diagnosis

The terms rectal varices and haemorrhoids are often used interchangeably, but this is not correct. Haemorrhoids are due to prolapse of the rectal venous plexus and are no more common in patients with portal hypertension than in those without. Rectal varices, however, are found only in patients with portal hypertension and are common in conditions such as cirrhosis.

Treatment

Unlike esophageal varices, rectal varices are less prone to bleeding, are less serious when a bleed does occur, and are easier to treat because of the more accessible location. However, in some cases, rectal varices can result in severe bleeding.

Typically, treatment consists of addressing the underlying portal hypertension. Some treatments include portosystemic shunting, ligation, and under-running suturing. Insertion of a transjugular intrahepatic portosystemic shunt (TIPS) has been shown to alleviate varices caused by portal hypertension. Successful treatment of portal hypertension that subsequently reduces anorectal varices provides a confirmation of the initial diagnosis, allowing for a distinction between varices and hemorrhoids, which would not have been alleviated by reduction of portal hypertension.

References

^ Katz, JA; Rubin, RA; Cope, C; Holland, G; Brass, CA (Jul 1993). "Recurrent bleeding from anorectal varices: successful treatment with a transjugular intrahepatic portosystemic shunt". The American Journal of Gastroenterology. 88 (7): 1104–7. PMID 8317414.
Hunt AH. 'A contribution to the study of portal hypertension. Edinburgh: Livingstone, 1958: 61.
^ Chawla, Y; Dilawari, J B (1 March 1991). "Anorectal varices--their frequency in cirrhotic and non-cirrhotic portal hypertension". Gut. 32 (3): 309–311. doi:10.1136/gut.32.3.309. PMC 1378841. PMID 2013427.
Moubarak, Elie; Bouvier, Antoine; Boursier, Jérôme; Lebigot, Jérôme; Ridereau-Zins, Catherine; Thouveny, Francine; Willoteaux, Serge; Aubé, Christophe (15 October 2011). "Portosystemic collateral vessels in liver cirrhosis: a three-dimensional MDCT pictorial review". Abdominal Imaging. 37 (5): 746–766. doi:10.1007/s00261-011-9811-0. PMID 22002160. S2CID 24223637.
^ Hosking, SW; Smart, HL; Johnson, AG; Triger, DR (1989-02-18). "Anorectal varices, haemorrhoids, and portal hypertension". Lancet. 1 (8634): 349–52. doi:10.1016/s0140-6736(89)91724-8. PMID 2563507. S2CID 29675644.
McCormack TT BHSJJA. Rectal varices are not piles. Br J Surg. Fev 1984;71(2):163.
Jacobs DM, Bubrick MP, Onstad GP, Hitchcock CR. The relationship of haemorrhoids to portal hypertension. Dis Col Rect 1980:23(8):567-9.
Zuberi FF ZBKMKM. Frequency of rectal varices in patients with cirrhosis. J Coll Physicians Surg Pak. Feb 2004;14(2):94-7.
Johansen K. Bardin J. Orloff MJ. Massive bleeding from hemorrhoidal varices in portal hypertension. JAMA 1980:224 (18): 2084-5.
Weinshel, E., Chen, W., Falkenstein, D. B., Kessler, R., & Raicht, R. F. (1986, March). Hemorrhoids or Rectal Varices: Defining the Cause of Massive Rectal Hemorrhage in Patients With Portal Hypertension. GASTROENTEROLOGY 1986;90:744-. https://www.gastrojournal.org/article/0016-5085(86)91132-7/pdf Archived: https://web.archive.org/web/20210617070007/https://www.gastrojournal.org/article/0016-5085%2886%2991132-7/pdf

External links

Classification	D ICD-10: I86.8

Diseases of the human digestive system

Upper GI tract

Esophagus

Stomach

Lower GI tract
Enteropathy

Small intestine (Duodenum/Jejunum/Ileum)	Enteritis Duodenitis Jejunitis Ileitis Peptic (duodenal) ulcer Curling's ulcer Malabsorption: Coeliac Tropical sprue Blind loop syndrome Small intestinal bacterial overgrowth Whipple's Short bowel syndrome Steatorrhea Milroy disease Bile acid malabsorption
Large intestine (Appendix/Colon)	Appendicitis Colitis Pseudomembranous Ulcerative Ischemic Microscopic Collagenous Lymphocytic Dysentery Functional colonic disease IBS Intestinal pseudoobstruction / Ogilvie syndrome Megacolon / Toxic megacolon Diverticulitis/Diverticulosis/SCAD
Large and/or small	Enterocolitis Necrotizing Gastroenterocolitis IBD Crohn's disease Vascular: Abdominal angina Mesenteric ischemia Angiodysplasia Bowel obstruction: Ileus Intussusception Volvulus Fecal impaction Constipation Functional Diarrhea Infectious Intestinal adhesions
Rectum	Proctitis Radiation proctitis Proctalgia fugax Rectal prolapse Anismus Solitary rectal ulcer syndrome Rectal stricture
Anal canal	Anal fissure/Anal fistula Anal abscess Hemorrhoid Anal dysplasia Pruritus ani Anal stricture

GI bleeding

Accessory

Liver	Hepatitis Viral hepatitis Autoimmune hepatitis Alcoholic hepatitis Cirrhosis PBC Fatty liver MASLD Vascular Budd–Chiari syndrome Hepatic veno-occlusive disease Portal hypertension Nutmeg liver Alcoholic liver disease Liver failure Hepatic encephalopathy Acute liver failure Liver abscess Pyogenic Amoebic Hepatorenal syndrome Peliosis hepatis Metabolic disorders Wilson's disease Hemochromatosis
Gallbladder	Cholecystitis Gallstone / Cholelithiasis Cholesterolosis Adenomyomatosis Postcholecystectomy syndrome Porcelain gallbladder
Bile duct/ Other biliary tree	Cholangitis Primary sclerosing cholangitis Secondary sclerosing cholangitis Ascending Cholestasis/Mirizzi's syndrome Biliary fistula Haemobilia Common bile duct Choledocholithiasis Biliary dyskinesia Sphincter of Oddi dysfunction
Pancreatic	Pancreatitis Acute Chronic Hereditary Pancreatic abscess Pancreatic pseudocyst Exocrine pancreatic insufficiency Pancreatic fistula

Other

Hernia

Lumbar
- Petit's
- Grynfeltt–Lesshaft

Undefined location

Peritoneal

Cardiovascular disease (vessels)

Arteries, arterioles
and capillaries

Inflammation	Arteritis Aortitis Buerger's disease
Arteriosclerosis	Atherosclerosis Foam cell Fatty streak Atheroma Cholesterol LDL Oxycholesterol Trans fat Monckeberg's arteriosclerosis Hyaline arteriolosclerosis Hyperplastic arteriolosclerosis
Peripheral artery disease	Stenosis Carotid artery stenosis Renal artery stenosis Aortoiliac occlusive disease Critical limb ischemia Degos disease Erythromelalgia Fibromuscular dysplasia Hepatic artery thrombosis Intermittent claudication Raynaud's phenomenon
Aneurysm / dissection / pseudoaneurysm	torso: Aortic aneurysm Abdominal aortic aneurysm Thoracic aortic aneurysm Aneurysm of sinus of Valsalva Aortic dissection Aortic rupture Coronary artery aneurysm head / neck Intracranial aneurysm Intracranial berry aneurysm Carotid artery dissection Vertebral artery dissection Familial aortic dissection
Vascular malformation	Arteriovenous fistula Arteriovenous malformation Telangiectasia Hereditary hemorrhagic telangiectasia Generalized essential telangiectasia
Vascular nevus	Cherry hemangioma Halo nevus Spider angioma

Veins

Inflammation	Phlebitis
Venous thrombosis / Thrombophlebitis	primarily lower limb Deep vein thrombosis abdomen Hepatic veno-occlusive disease Budd–Chiari syndrome May–Thurner syndrome Portal vein thrombosis Renal vein thrombosis upper limb / torso Mondor's disease Paget–Schroetter disease Pulmonary embolism head Cerebral venous sinus thrombosis Post-thrombotic syndrome
Varicose veins	Gastric varices Portacaval anastomosis Caput medusae Esophageal varices Hemorrhoid Varicocele
Other	Chronic venous insufficiency Chronic cerebrospinal venous insufficiency Superior vena cava syndrome Inferior vena cava syndrome Venous ulcer

Arteries or veins

Blood pressure

Hypertension	Hypertensive heart disease Hypertensive emergency Hypertensive nephropathy Essential hypertension Secondary hypertension Renovascular hypertension Benign hypertension Pulmonary hypertension Systolic hypertension White coat hypertension
Hypotension	Orthostatic hypotension Shock (circulatory)

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