• Weiwei Li, Jianli Wang, Hua Fu, and Jinlong Liu.
• Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China.
• Medicine (Baltimore). 2022 Jul 29; 101 (30): e30024e30024.

RationaleEctopic varices are the collateral circulation of portal vein located anywhere in the gastrointestinal tract other than the esophageal and gastric regions. Rupture of these varices often results in life-threatening hemorrhage. Management guidelines for ectopic variceal bleeds are not yet standardized because cases are rare and treatment approaches described in the literature vary considerably.Patient ConcernsA 53-year-old woman with a 20-year history of chronic hepatitis C cirrhosis came to our hospital for treatment due to intermittent black stools for 4 days. After admission, the patient developed hemorrhagic shock, with hemodynamic instability.DiagnosisPostoperative histological examination confirmed the diagnosis of sigmoid varicose veins.InterventionEmergency colonoscopy showed that a varicose vein mass in the sigmoid colon wall 30 cm from the anus was ruptured and bleeding. Percutaneous transhepatic inferior mesenteric venography revealed the presence of a varicose mass of sigmoid colon veins. After embolization of the sigmoid varicose veins with spring coils, angiography showed that the hemorheology of the distal varicose vein mass was slow but not completely blocked. Three days after embolization, the patient had hematochezia again. Splenectomy and sigmoid colon resection were performed immediately.OutcomesFollow-up computed tomography showed no residual varices were observed after sigmoid colon resection.LessonsEctopic varices, which are rare sequelae of portal hypertension, need to be taken seriously because bleeding from these varices can be catastrophic. We report a case of isolated sigmoid variceal rupture and hemorrhage due to portal hypertension in cirrhosis. The patient experienced failure of endoscopic hemostasis and sigmoid colon venous coil embolization. She was eventually successfully brought to hemostasis by surgery.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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