[Anal varix in a patient with liver cirrhosis]

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In the lower GI tract, collaterals between the superior hemorrhoidal vein (portal) and the middle and inferior hemorrhoidal veins (systemic) result in anal and rectal varices. Hemorrhoids must be differentiated from anal varices; the former appear as purple, well-vascularized mucosa in the lower 4 cm of the anal canal. Varices in the anal canal appear as either discrete vein or saccular blue or slate grey swellings. Rectal varicex start above the pectinate line and are easy to diagnose. [Ginsberg textbook 2005]

a fatal case