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The aim of this study was to assess the ultrasonographic abnormalities of the rectal wall and surrounding structures in patients with cirrhosis and to correlate these findings with endoscopy. From November 1992 to May 1993, 53 cirrhotic patients and 30 control subjects were examined by transrectal ultrasonography and rectoscopy. In addition to rectoscopy and transrectal ultrasonography, patients with cirrhosis underwent an upper gastrointestinal endoscopy. Ultrasonography abnormalities of the rectum were detected in 32 cases of cirrhosis (60.5%): a) in 21 cases the rectal wall thickness was greater than 5 mm and the sub-mucosa was thickened ( > or = 2 mm) and dissected by thin echo-free elements; b) the remaining 11 patients presented, in addition to the previously described abnormalities, rounded elongated echo-free structures surrounding the rectum which were not found in the control group. All these 11 patients had rectal varices at rectoscopy. In the group of cirrhotic patients, rectoscopy showed abnormal dilated veins in 23 cases (43.5%) and rectal varices in 11 cases. Ultrasonographic and endoscopic abnormalities of the rectum were more often visualized in the group of cirrhotic patients than in the control group (P < 0.001). In patients with cirrhosis, the demonstration of rectal varices was associated with transrectal ultrasound abnormalities (P < 0.01), and in particular peri-rectal vascular formations. In cases of cirrhosis the rectal wall abnormalities were not associated with gastric varices at endoscopic inspection but were linked with large esophageal varices or gastric mucosal abnormalities demonstrated on endoscopy (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

We report the case of a young man presenting clinical features of portal hypertension of unknown origin. The ultrasonographic examination showed suprahepatic blockage signs leading to the diagnosis of Budd-Chiari syndrome caused by incomplete diaphragm of the inferior vena cava. The color Doppler examination suggested caval obstruction, showing an abrupt shift from a laminar to a bosterous flux. Secondly cavograms and surgery later confirmed the diagnosis.