Tomita D, Yamamoto M, Wakamatsu M, Shibayama R, Maeda Y, Hiramatsu K, Hanaoka Y, Toda S, Ueno M, Matoba S, Kuroyanagi H. Anastomotic colonic varices after colectomy treated by obliteration via a transhepatic portal approach: A case report. World J Gastroenterol 2026; 32(18): 118499 [DOI: 10.3748/wjg.v32.i18.118499]
Corresponding Author of This Article
Daisuke Tomita, MD, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku 1058470, Tokyo, Japan. dai0127027@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
May 14, 2026 (publication date) through May 6, 2026
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Journal Information of This Article
Publication Name
World Journal of Gastroenterology
ISSN
1007-9327
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Tomita D, Yamamoto M, Wakamatsu M, Shibayama R, Maeda Y, Hiramatsu K, Hanaoka Y, Toda S, Ueno M, Matoba S, Kuroyanagi H. Anastomotic colonic varices after colectomy treated by obliteration via a transhepatic portal approach: A case report. World J Gastroenterol 2026; 32(18): 118499 [DOI: 10.3748/wjg.v32.i18.118499]
Daisuke Tomita, Masato Wakamatsu, Ryo Shibayama, Yusuke Maeda, Kosuke Hiramatsu, Yutaka Hanaoka, Shigeo Toda, Masashi Ueno, Shuichiro Matoba, Hiroya Kuroyanagi, Department of Gastroenterological Surgery, Toranomon Hospital, Minato-ku 1058470, Tokyo, Japan
Masayoshi Yamamoto, Department of Radiology, Teikyo University Hospital, Itabashi-ku 1738606, Tokyo, Japan
Shuichiro Matoba, Division of General and Gastroenterological Surgery, Department of Surgery, Toho University Omori Medical Center, Ota-ku 1438541, Tokyo, Japan
Co-first authors: Daisuke Tomita and Masayoshi Yamamoto.
Author contributions: Tomita D and Yamamoto M conceived the study and wrote the manuscript and they contribute equally to this study as co-first authors; Tomita D, Yamamoto M, Wakamatsu M, Shibayama R and Maeda Y contributed to the operation, follow-up, design, and coordination; Hiramatsu K, Hanaoka Y, Toda S, Ueno M, Matoba S and Kuroyanagi H aided in interpreting the results and supervised the project; all the authors have read and approved the final version of the manuscript and all authors agree with the contents of this manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Daisuke Tomita, MD, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku 1058470, Tokyo, Japan. dai0127027@gmail.com
Received: January 5, 2026 Revised: February 2, 2026 Accepted: February 24, 2026 Published online: May 14, 2026 Processing time: 122 Days and 22.3 Hours
Abstract
BACKGROUND
Colonic anastomotic varices are extremely rare, particularly in patients without portal hypertension. Their clinical presentation is often nonspecific, and standardized diagnostic and therapeutic strategies have not yet been established. We report a unique case of recurrent lower gastrointestinal bleeding from transverse colonic anastomotic varices in a noncirrhotic patient who was successfully treated with percutaneous embolization.
CASE SUMMARY
A 65-year-old man with a history of laparoscopic transverse colectomy presented with recurrent melena at 30-, 35-, and 38-month postoperatively. Colonoscopy repeatedly demonstrated active bleeding from dilated submucosal veins at the anastomotic site, and endoscopic clipping provided only temporary hemostasis. Laboratory tests revealed preserved hepatic function, and imaging revealed no findings suggestive of portal hypertension. Due to refractory bleeding and the invasive nature of the reoperation, an interventional radiology (IR) approach was selected. Computed tomography portography revealed venous convergence in both the superior and inferior mesenteric systems at the anastomotic site. Targeted embolization via the transhepatic portal approach successfully achieved complete obliteration of varices. The patient did not experience further bleeding during the months of follow-up.
CONCLUSION
IR is an effective and minimally invasive treatment option for refractory anastomotic colonic varices in patients without portal hypertension.
Core Tip: Colonic anastomotic varices are extremely rare, particularly in patients without cirrhosis or portal hypertension, and optimal management has not been established. We describe a unique case of recurrent bleeding from transverse colonic anastomotic varices after colectomy, in which several endoscopic attempts at hemostasis were unsuccessful. Angiography revealed localized venous congestion at the anastomosis, prompting targeted embolization using a transhepatic interventional radiological approach. This case underscores the need to consider anastomotic varices as a potential late postoperative bleeding source and shows that coordinated treatment planning across multiple specialties is essential for selecting the most appropriate therapeutic strategy.
