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An Unusual Case of Rectal Bleeding

Open AccessPublished:July 07, 2022DOI:https://doi.org/10.1016/j.gastha.2022.07.001
      A 60-year-old man presented at the emergency department with a history of prolapsed hemorrhoids and recurrent hematochezia.
      The patient was in optimal cardiorespiratory condition and had no complaints till the anal bleeding and hemorrhoidal pain.
      During physical examination, a “caput medusae”-like appearance of the inferior epigastric vein was noted (Figure A shows the inferior epigastric vein). On computed tomography scan of the abdomen, the aplasia of the inferior vena cava (IVC) could be displayed as well as the renal veins merging into an expanded azygos and hemiazygos veins (Figure B, the arrows show expanded azygos and hemiazygos).
      In patients with aplasia of the IVC, the venous flow is directed through the azygos and hemiazygos, paravertebral, and abdominal wall veins. The venous hypertension causes increased blood flow via the perirectal hemorrhoidal collateral circulation. Congested mucosal and submucosal tissue can be seen on colonoscopic examination, increasing the risk of hematochezia, as shown in our patient.