It Runs in the Family: A Rare Case of Familial Idiopathic Colonic Varices.

Background: Colonic varices (CV) remain an extremely rare condition, the usual cause of which is portal hypertension due to liver disease, chronic pancreatitis or malignancy. Here we present a case of familial idiopathic CV in a middle-aged female, complicated by a polyp removal during colonoscopy.

Case presentation: A 57-year-old female with a past medical history of 5 months of melena, polyps and hemorrhoids diagnosed with idiopathic CV during diagnostic colonoscopy. She had no prior history of liver disease, pancreatic disease, non-steroidal anti-inflammatory drugs (NSAID) use, or blood thinner use. She was later found to have a family history of the condition.

Conclusion: The rarity of this case is of particular concern for clinicians due to its life threatening complication of severe lower gastrointestinal bleed - a true medical emergency. This is particularly difficult in the absence of usual predisposing triggers. Differential diagnoses should be considered in patients that present with rectal bleeding of unknown cause.