Giant rectal varix in a patient with portal hypertension

A 46-year-old man with no history of interest except for a non-filial cryptogenic portal cavernomatosis diagnosed in 1994 with an inconclusive biopsy. He first came to our clinic in 2011 for examination for rectorrhagia and sensation of anal mass.

Physical examination revealed grade 1 haemorrhoids that did not justify the symptoms. An MRI was requested to rule out pelvic pathology, which revealed a large varicose dilatation of up to 4 cm extending from the hepatic hilum to the left flank and hypogastrium, which remained unchanged in the last MRI, from which the photographs were obtained (Figs. 1 and 2).

Fig. 1.

Pelvic MRI in axial section with LAVA sequence. The rectum (arrow) and the adjacent rectal varicose vein (asterisk) are visualised.

Fig. 2.

Pelvic MRI in coronal section with LAVA sequence. The collapsed rectum (arrow) and adjacent rectal varicose vein (asterisk) are visualised.