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Abstract

Abstract


We report a case of isolated bladder varices that manifested with sudden onset, gross hematuria, in a 44-year-old male with no co-morbid conditions. Varicosities were discovered on cystoscopy. Conditions to look out for in such a situation are discussed.
Introduction
Enlarged veins are called varicosities. Varicosities in the bladder are uncommon. They are typically associated with other conditions such as portal hypertension, shistosomiasis, pregnancy, Ataxia Telangectasia and Klippel Trenaunay syndrome.1-5 We report a case of bladder varices that manifested with sudden gross hematuria, in an otherwise healthy male.
Case Report
A 44 year old healthy male from Afghanistan, presented for evaluation of a single episode of gross, total haematuria with clots six months ago. There was associated dysuria. There were no triggering factors, no associated fever or any symptoms of a urinary tract infection. The haematuria resolved spontaneously, without any intervention. He complained of a discharging perianal sinus since 3 years. He had undergone appendectomy at the age of nineteen years. He had no co morbid conditions and there was no history of hospital admissions or blood transfusions in the past. He had not been on any medications. He was a smoker, having smoked 15 pack years (one pack per day for the last 15 years). He used to consume alcoholic beverages occasionally. His family history was positive for hypertension on the paternal side. There were no known allergies. He was an architect by profession. His weight was stable in the past few years, and he had no urinary or bowel complaints.    A detailed general physical examination revealed nicotine staining of his tongue and finger tips of the right hand, secondary to his habit of smoking. He had no pallor or icterus. On examination of the chest he had a 0.5x0.5 cm sebaceous cyst in his right axilla in the mid clavicular line at the level of fourth inter-costal space. He also had a 7x7 cm soft mass most probably a lipoma, over the right hypochondrium and right iliac fossa scar of his appendectomy. Rest of the systemic examination was unremarkable. To evaluate the problem, lab tests, abdominal ultrasound and cystoscopy was done. The laboratory investigations showed: haemoglobin; 16.3gm/dL (normal: 13.7-16.3), haematocrit; 48.4 % (41.9-48.7), white blood cell count; 9.1x109/dL (4-109) platelet count: 235,000/mm3 (150-400 x 103). His Fasting Blood Glucose was 89mg/dL (normal: 65-110). Liver function tests showed a total bilirubin of 1mg/dL (normal = 0.2-1.25), Gamma Glutamyl Transferase of 52 IU/L (normal = 3-50) and Alanine Amino Transferase of 56 IU/L (normal = 0-55). His serum uric acid level was 7.5 mg/dL (normal = 4.1-8), serum cholesterol was 220 mg/dl (normal = 35) and LDL was 110 mg/dL (