Rectal Bleeding from Downhill Esophageal Varices: A Case Report
Zineb Boukhal, Sara Abadi, Naybi Houda, Fatima Zahra El Rhaoussi, Mohamed Tahiri, Fouad Haddad, Wafaa Hliwa, Ahmed Bellabah, Wafaa Badre
Asian Journal of Research and Reports in Gastroenterology · pp. 268–271 · Published 30 Oct 2025
10.9734/ajrrga/2025/v8i1189Abstract
There are three reported types of esophageal varices, classified based on direction of venous flow: “uphill,” “downhill,” or idiopathic. The most common type, “uphill,” is related to portal hypertension. In contrast, “downhill” esophageal varices usually result from obstruction or compression of the superior vena cava. We report the case of a 61-year-old woman admitted for massive rectal bleeding, in the context of a progressive toxic goiter, in whom the diagnosis of downhill varices was established. Endoscopic band ligation successfully controlled the hemorrhage, with no recurrence. Downhill varices are a rare cause of acute upper gastrointestinal bleeding. Their presentation as isolated lower gastrointestinal “rectal” bleeding makes this case a clinically intriguing, highlighting the complexity of venous circulation disturbances secondary to superior vena cava compression and presents valuable contribution to the literature on this entity.
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