Year 2016 / Volume 108 / Number 8
Digestive Diseases Image
Hemangioma of the rectum - How misleading can hematochezia be?

500-501

Sofia Vitor, Alexandre Oliveira Ferreira, João Lopes, José Velosa,

Abstract
We present the case of an 18-year-old male patient that was referred to our gastrenterology department with history of intermittent painless hematochezia since childhood. During such instances, he was diagnosed with bowel intussusception, eosinophilic gastroenteritis and inflammatory bowel disease at 4, 6 and 8 years old, respectively. He underwent treatment with 5-aminosalicylic acid for two years, without improvement of symptoms. He was then lost to follow-up until our observation. His physical examination was unremarkable except for digital rectal examination which found a nodular compressible mass by the palpating finger. Blood tests revealed a mild iron deficiency anemia. The colonoscopy showed an extended reddish and bluish multinodular submucosal mass in the rectum, suggesting diffuse cavernous hemangioma of the rectum (DHCR). The Magnetic Resonance Imaging, showed diffuse thickening of the entire rectum extending into the distal sigmoid with the mesorectum revealing multiple serpiginous structures, corresponding to abnormal blood vessels. After discussion, we considered to perform a sphincter-sparing procedure, namely pull through transection and coloanal anastomosis. However, intervention was ruled out by the patient because of his fear of anal incontinence and permanent colostomy. We adopted a conservative strategy with clinical surveillance and iron supplementation. At the present, the patient remains with intermittent rectal bleeding, referring poor quality of life due to his ongoing symptoms. This is a rare case of DHCR. Despite of being a benign disease, the management of DHCR requires a sphincter mucosectomy and pull-through coloanal sleeve anastomosis which has become the first-line procedure. The surgical outcomes are non-expectable in 32% with permanent sphincter lesion or with incomplete DHCR removal. As in this case, the surgeons or patients refusal to perform the intervention is common which represents a challenge to the clinical follow-up.
Share Button
New comment
Comments
No comments for this article
References
1 - Wang HT, Gao XH, Fu CG, et al. Diagnosis and Treatment of Diffuse Cavernous Hemangioma of the Rectum: Report of 17 Cases. World J Surg 2010;34:2477-86. DOI: 10.1007/s00268-010-0691-1
2 - Chatu S, Kumar D, Du Parcq J, et al. A rare cause of rectal bleeding masquerading as proctitis. J Crohns Colitis. 2013;7:99-102. DOI: 10.1016/j.crohns.2012.05.022.
3 - Tan M, Mutch M. Hemangiomas of the Pelvis. Clin Colon Rectal Surg. 2006;19:94-101. DOI: 10.1055/s-2006-942350
4 - Hervías D, Turrión JP, Herrera M, et al. Diffuse cavernous hemangioma of the rectum: an atypical cause of rectal bleeding. Rev Esp Enferm Dig. 2004;96:346-52. DOI: 10.4321/S1130-01082004000500008
Citation tools
Vitor S, Oliveira Ferreira A, Lopes J, Velosa J. Hemangioma of the rectum - How misleading can hematochezia be?. 3931/2015


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 670 visits.
This article has been downloaded 62 times.
Publication history

Received: 16/07/2015

Accepted: 21/07/2015

Published: 29/07/2016

Article revision time: 4 days

Article editing time: 379 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology