# Unmasking Portal Colopathy: A Case of Rectal Bleeding in a Patient With Liver Cirrhosis Misdiagnosed as Ulcerative Colitis

## TL;DR

A patient with liver cirrhosis had rectal bleeding misdiagnosed as ulcerative colitis, but it was actually caused by portal hypertensive colopathy.

## Contribution

This case highlights the diagnostic challenges of distinguishing portal hypertensive colopathy from ulcerative colitis in patients with cirrhosis.

## Key findings

- Portal hypertensive colopathy can present with rectal bleeding and mimic ulcerative colitis.
- Chronic HBV infection can lead to decompensated cirrhosis and its complications.
- Accurate diagnosis requires considering liver disease in patients with gastrointestinal symptoms.

## Abstract

This report outlines the diagnostic journey of a 31-year-old female patient with chronic hepatitis B virus (HBV) infection who presented with acute rectal bleeding. Initially, she was misdiagnosed with ulcerative colitis at a primary care center, though the underlying cause of her symptoms was related to cirrhosis and its complication, portal hypertensive colopathy (PHC). At presentation, she revealed a history of ascites a few months before the onset of rectal bleeding, which had been managed with diuretics. Subsequent investigations led to a revised diagnosis of decompensated cirrhosis secondary to chronic HBV infection, with PHC identified as the cause of her rectal bleeding. This case highlights the diagnostic challenges faced when managing patients with coexisting cirrhosis and gastrointestinal bleeding, initially misdiagnosed as ulcerative colitis.