2017-10-05 12:28:21 UTC

Image Challenge: An Unusual Cause of Hematochezia

Oct. 5, 2017

Patient presents with drop bright red blood after defecation, severe anemia but normal coagulation function, serum ammonia and liver function.

Gastroenterology Clinical Image Challenge: A 21-year-old man with a three-year history of hematochezia presented to the gastroenterology department with drop bright red blood after defecation, which was aggravated after eating spicy foods. He denied any history of hepatitis. On physical examination, the patient had an anemic appearance. Laboratory tests showed severe anemia (hemoglobin, 2.8 g/dL), but normal coagulation function, serum ammonia and liver function. Colonoscopy showed internal hemorrhoids with no other abnormalities. Contrast-enhanced computed tomography revealed large varicose dilatation of the splenic and superior mesenteric veins, pronounced dilatation of the inferior mesenteric vein (Figure A) and dilatation of the pelvic rectal venous plexus (Figure B). However, the intrahepatic portal veins and liver size were normal. The patient was diagnosed with hematochezia owing to internal hemorrhoids.

What is the cause of internal hemorrhoids?

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