Even in the absence of demonstrable esophagogastric varices in the cirrhotic patient, a diagnosis of variceal bleeding from unusual sites should be entertained in the differential diagnosis of massive lower gastrointestinal hemorrhage. The varices may reflect the increased pressure in the superior or inferior mesenteric systems or in the splenic system through abnormal splenocolic anastomoses. This case has the unique feature of bleeding from varices interposed between the splenic and inferior mesenteric venous systems, as opposed to the previously described cases of varices draining directly into a portosystemic conduit.
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