Saudi Journal of Gastroenterology
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Year : 2011  |  Volume : 17  |  Issue : 6  |  Page : 421-422
Unusual cause of rectal bleeding

Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India

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Date of Web Publication5-Nov-2011

How to cite this article:
Garg PK, Kumar A. Unusual cause of rectal bleeding. Saudi J Gastroenterol 2011;17:421-2

How to cite this URL:
Garg PK, Kumar A. Unusual cause of rectal bleeding. Saudi J Gastroenterol [serial online] 2011 [cited 2022 Sep 27];17:421-2. Available from:

A 19-year-old young man presented with multiple episodes of rectal bleeding of 2 years duration. On physical examination, he had severe pallor and an asymmetric, edematous hypertrophy of left lower limb with multiple dilated and tortuous veins present along the posterolateral aspect [Figure 1]. Laboratory evaluation demonstrated significant anemia with hemoglobin of 6.9 g/dL and hematocrit of 20.9%. Diagnostic colonoscopy demonstrated venous ectasia extending from the dentate line to descending colon [Figure 2]. No active bleeding was noted. Esophago-gastroduodenoscopy was unremarkable.
Figure 1: Clinical photograph showing asymmetric, edematous hypertrophy of left lower limb

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Figure 2: Colonoscopy showing multiple venous ectasia in rectum

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   Question Top

Q1. What is the diagnosis?

   Answer Top

The clinical picture is consistent with the diagnosis of Klippel-Trenaunay Syndrome (KTS). Noted French physicians Maurice Klippel and Paul Trenaunay described this syndrome in 1900 which is characterized by a triad of vascular malformations, venous varicosity and bony and/or soft tissue hypertrophy. [1] Visceral vascular malformations are uncommon in KTS but may cause significant morbidity and mortality. [2] Gastrointestinal malformations are more common than those of genitourinary tract. Bleeding is the most common manifestation of intestinal vascular malformations and may prove to be a potentially life-threatening emergency. Platelet sequestration with secondary consumption of clotting factors within the venous sinusoids of the visceral vascular malformations may further enhance bleeding (Kasabach-Merritt phenomenon). [3]

   References Top

1.Jacob AG, Driscoll DJ, Shaughnessy WJ, Stanson AW, Clay RP, Gloviczki P. Klippel-Trénaunay syndrome. Spectrum and management. Mayo Clin Proc 1998;73:28-36.  Back to cited text no. 1
2.Servelle M, Bastin R, Loygue J, Montagnani A, Bacour F, Soulie J, et al. Hematuria and rectal bleeding in the child with Klippel and Trénaunay syndrome. Ann Surg1976;183:418-28.  Back to cited text no. 2
3.Abass K, Saad H, Kherala M, Abd-Elsayed AA. Successful treatment of kasabach-merritt syndrome with vincristine and surgery: a case report and review of literature. Cases J 2008;1:9.  Back to cited text no. 3

Correspondence Address:
Pankaj K Garg
Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi - 110 095
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-3767.87187

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  [Figure 1], [Figure 2]


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