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Unusual association of diseases/symptoms
An unusual differential diagnosis of a left iliac fossa mass
  1. Rynn Lee1,
  2. Sarah Liptrot2,
  3. Aidan Shaw3,
  4. Nicholas Hurst4
  1. 1
    Department of Ophthalmology, Queen’s Medical Centre, Derby Road, Nottingham NG7 2UH, UK
  2. 2
    Department of General Surgery, King’s Mill Hospital, Mansfield Road, Sutton-In-Ashfield NG17 4JL, UK
  3. 3
    Department of Radiology, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
  4. 4
    Department of General Surgery, Derby City General Hospital, Uttoxeter Road, Derby, Derbyshire DE22 3NE, UK
  1. Rynn Lee, rynnlee{at}


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.

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  • Competing interests: none.

  • Patient consent: Patient/guardian consent was obtained for publication.

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