View source for Medicine:Anorectal varices

{{Not to be confused with|Haemorrhoid}}{{short description|Dilated veins in the anus caused by portal hypertension that may lead to haemorrhage}}
{{Infobox medical condition (new)
| name          = Anorectal varices
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| specialty     = [[Medicine:Gastroenterology|Gastroenterology]], [[Medicine:Hematology|Hematology]]
| symptoms      = Coffee ground vomiting, [[Medicine:Hematochezia|Hematochezia]]
| complications = [[Medicine:Internal bleeding|Internal bleeding]], [[Medicine:Hypovolemic shock|hypovolemic shock]], [[Medicine:Cardiac arrest|cardiac arrest]]
| onset         =
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| causes        = [[Medicine:Portal hypertension|Portal hypertension]]
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| treatment     = Treating [[Medicine:Portal hypertension|portal hypertension]], surgery ([[Medicine:Transjugular intrahepatic portosystemic shunt|transjugular intrahepatic portosystemic shunt]])
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'''Anorectal varices''' are the [[Medicine:Vasodilation|dilation]] of collateral submucosal vessels due to backflow in the veins of the [[Biology:Rectum|rectum]].<ref name="Katz1993">{{cite journal|last1=Katz|first1=JA|last2=Rubin |first2=RA |last3=Cope |first3=C |last4=Holland |first4=G |last5=Brass |first5=CA|title=Recurrent bleeding from anorectal varices: successful treatment with a transjugular intrahepatic portosystemic shunt.|journal=The American Journal of Gastroenterology|date=Jul 1993|volume=88|issue=7|pages=1104–7|pmid=8317414}}</ref> Typically this occurs due to [[Medicine:Portal hypertension|portal hypertension]] which shunts venous blood from the portal system through the [[Medicine:Portacaval anastomosis|portosystemic anastomosis]] present at this site into the systemic venous system.<ref>Hunt AH. 'A contribution to the study of portal hypertension. Edinburgh: Livingstone, 1958: 61.</ref><ref name="Chawla1991">{{cite journal|last=Chawla|first=Y|author2=Dilawari, J B|title=Anorectal varices--their frequency in cirrhotic and non-cirrhotic portal hypertension.|journal=Gut|date=1 March 1991|volume=32|issue=3|pages=309–311|doi=10.1136/gut.32.3.309|pmid=2013427|pmc=1378841}}</ref> This can also occur in the [[Biology:Esophagus|esophagus]], causing [[Medicine:Esophageal varices|esophageal varices]], and at the level of the umbilicus, causing [[Medicine:Caput medusae|caput medusae]].<ref>{{cite journal|last1=Moubarak|first1=Elie|last2=Bouvier |first2=Antoine |last3=Boursier |first3=Jérôme |last4=Lebigot |first4=Jérôme |last5=Ridereau-Zins |first5=Catherine |last6=Thouveny |first6=Francine |last7=Willoteaux |first7=Serge |last8=Aubé |first8=Christophe|title=Portosystemic collateral vessels in liver cirrhosis: a three-dimensional MDCT pictorial review|journal=Abdominal Imaging|volume=37|issue=5|pages=746–766|date=15 October 2011|doi=10.1007/s00261-011-9811-0|pmid=22002160|s2cid=24223637}}</ref> Between 44% and 78% of patients with portal hypertension get anorectal varices.<ref name="Chawla1991" /><ref name="Hosking1989">{{cite journal|last1=Hosking|first1=SW|last2=Smart |first2=HL |last3=Johnson |first3=AG |last4=Triger |first4=DR|title=Anorectal varices, haemorrhoids, and portal hypertension.|journal=Lancet|date=1989-02-18|volume=1|issue=8634|pages=349–52|pmid=2563507|doi=10.1016/s0140-6736(89)91724-8|s2cid=29675644}}</ref>
==Signs and symptoms==
==Pathogenesis==
Blood from the superior portion of the [[Biology:Rectum|rectum]] normally drains into the superior rectal vein and via the inferior mesenteric vein to the [[Biology:Liver|liver]] as part of the [[Biology:Portal venous system|portal venous system]]. Blood from the middle and inferior portions of the [[Biology:Rectum|rectum]] is drained via the middle and inferior rectal veins. In [[Medicine:Portal hypertension|portal hypertension]], venous resistance is increased within the [[Biology:Portal venous system|portal venous system]]; when the pressure in the portal venous system increases above that of the systemic, blood is shunted through the [[Medicine:Portacaval anastomosis|portosystemic anastomoses]]. The shunting of blood and consequential increase of pressure through the collateral veins causes the [[Medicine:Varicose veins|varicosities]].{{cn|date=February 2021}}

==Diagnosis==
The terms rectal varices and haemorrhoids are often used interchangeably, but this is not correct.<ref>McCormack TT BHSJJA. Rectal varices are not piles. Br J Surg. Fev 1984;71(2):163.</ref> Haemorrhoids occur due to prolapse of the rectal venous plexus and are no more common in patients with portal hypertension than those without.<ref>Jacobs DM, Bubrick MP, Onstad GP, Hitchcock CR. The relationship of haemorrhoids to portal hypertension. Dis Col Rect 1980:23(8):567-9.</ref> Rectal varices, however, are only found in patients with portal hypertension and are common in conditions such as [[Medicine:Cirrhosis|cirrhosis]].<ref>Zuberi FF ZBKMKM. Frequency of rectal varices in patients with cirrhosis. J Coll Physicians Surg Pak. Feb 2004;14(2):94-7.</ref>

==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.<ref>Johansen K. Bardin J. Orloff MJ. Massive bleeding from hemorrhoidal varices in portal hypertension. JAMA 1980:224 (18): 2084-5.</ref> However, in some cases, rectal varices can result in severe bleeding. <ref>Weinshel, E., Chen, W., Falkenstein, D. B., Kessler, R., &amp; 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 </ref>

Typically, treatment consists of addressing the underlying portal hypertension. Some treatments include portosystemic shunting, ligation, and under-running suturing.<ref name="Hosking1989" /> Insertion of a [[Medicine:Transjugular intrahepatic portosystemic shunt|transjugular intrahepatic portosystemic shunt]] (TIPS) has been shown to alleviate varices caused by portal hypertension.<ref name="Katz1993" /> 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.{{cn|date=February 2021}}

==References==
{{reflist}}

==External links==
{{medical resources
|ICD10 = {{ICD10|I86.8}}
}}

{{Gastroenterology}}
{{Vascular diseases}}

[[Category:Colorectal surgery]]

{{Sourceattribution|Anorectal varices}}