Año 2016 / Volumen 108 / Número 8
Imagen en Patología Digestiva
Hemangioma of the rectum - How misleading can hematochezia be?

500-501

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

Resumen
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.
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Bibliografía
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
Instrucciones para citar
Vitor S, Oliveira Ferreira A, Lopes J, Velosa J. Hemangioma of the rectum - How misleading can hematochezia be?. 3931/2015


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Ficha Técnica

Recibido: 16/07/2015

Aceptado: 21/07/2015

Publicado: 29/07/2016

Tiempo de revisión del artículo: 4 días

Tiempo de edición del artículo: 379 días


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