Anorectal varices

Hepatomegaly or atrophic liver cirrhosis, splenomegaly, skin stigmata of liver diseases, anorectal varices, oedema or ascites, epigastric pulsation, congested neck veins, venous patterns on the surface of the abdomen, and vessel sounds (e.g. venous hum, machinery murmur). 

Blood from the haemorrhoidal venous plexus passes via the azygous superior rectal vein into the inferior mesenteric vein and thereafter into the portal vein. By contrast, the paired middle rectal vein and inferior rectal vein discharge their blood via the iliac vein into the inferior vena cava. In portal hypertension, anorectal varices are found in the region of the rectum, the anal canal and the external anal region. Haemorrhoids are distended and dislocated cavernous bodies in the rectum, which have no connection to the portal venous system. Although haemorrhoids and anorectal varices are two different clinical pictures, it is quite possible for them to occur simultaneously. The frequency of anorectal varices (40-80%) is dependent upon the extent and duration of portal hypertension. The bleeding tendency is low (7-14%). However, there have also been reports of massive haemorrhages. (21,45,55,66,83,105,156) (s. tab. 14.10)... 

Chawla, ., Dllawarl, JJ. Anorectal varices-their frequency in dr-rhotic and non-cirrhotic portal hypertension. Gut 1991 32 309 - 311... 

Misra, S.R, Misra, V., Dwivedi, M. Effect of esophageal variceal band ligation on hemorrhoids, anorectal varices, and portal hypertensive colopathy. Endoscopy 2002 34 195-198... 

Ory, G., Spahr, L., Megevand, J.M., Becker, C., Hadengue, A. The long-term efficacy of the intrahepatic portosystemic shunt (TIPS) for the treatment of bleeding anorectal varices in cirrhosis. A case report and review of the literature. Digestion 2001 64 261-264... 

Anorectal varices originate from the superior rectal vein, which is connected to the portal vein system. This portacaval anastomosis drains the blood into the iliac vein. Occasionally, massive bleeding may occur from rectal varices. Endoscopy is required for diagnosis and sclerotherapy. (70) (s. p. 256)... 

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