Rectal Bleeding from Downhill Esophageal Varices: A Case Report
Zineb Boukhal
Gastroenterology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
Sara Abadi
*
Gastroenterology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
Naybi Houda
Gastroenterology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
Fatima Zahra El Rhaoussi
Gastroenterology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
Mohamed Tahiri
Gastroenterology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
Fouad Haddad
Gastroenterology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
Wafaa Hliwa
Gastroenterology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
Ahmed Bellabah
Gastroenterology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
Wafaa Badre
Gastroenterology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
There are three reported types of esophageal varices, classified based on direction of venous flow: “uphill,” “downhill,” or idiopathic. The most common type, “uphill,” is related to portal hypertension. In contrast, “downhill” esophageal varices usually result from obstruction or compression of the superior vena cava. We report the case of a 61-year-old woman admitted for massive rectal bleeding, in the context of a progressive toxic goiter, in whom the diagnosis of downhill varices was established. Endoscopic band ligation successfully controlled the hemorrhage, with no recurrence. Downhill varices are a rare cause of acute upper gastrointestinal bleeding. Their presentation as isolated lower gastrointestinal “rectal” bleeding makes this case a clinically intriguing, highlighting the complexity of venous circulation disturbances secondary to superior vena cava compression and presents valuable contribution to the literature on this entity.
Keywords: Esophageal varices, blood flow, Metformin, rectal bleeding