Open AccessAn unusual differential diagnosis of a left iliac fossa mass
Author(s) -
Rynn Lee,
Sarah Liptrot,
A Shaw,
Nicholas Hurst
Publication year - 2009
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr.01.2009.1431
Subject(s) - medicine , cirrhosis , portal hypertension , varices , hepatic encephalopathy , differential diagnosis , coagulopathy , surgery , shunting , ascites , interventional radiology , radiology , pathology
We present a case of decompensated alcoholic liver cirrhosis with widespread porto-systemic anastamoses that resulted in varices within the rectus muscle. A literature review reveals only two similar cases previously. Intramuscular varices may predispose to local haemorrhage, especially in those with underlying coagulopathy as a result of liver cirrhosis. Management options include optimising medical management of the underlying condition, simple analgesics, and for those at high risk of bleeding, decompression by transjugular intrahepatic porto-systemic shunting. Interim monitoring by ultrasonography is also helpful in detecting rapid increases in vascular size. In our case the patient continued to drink heavily and developed hepatic encephalopathy. Her prognosis remains poor and is currently a poor candidate for any surgical intervention.