[ColonTODAY 108. Colorectal hemangioma or vascular malformation]
Parasite | Eso | Sto | Cancer | ESD
[ColonTODAY 108. Colorectal hemangioma or vascular malformation]
Hemangiomas and vascular malformations of the gastrointestinal tract, rare clinical entities, present as overt or occult bleeding. They can be distributed throughout the intestinal digestive system, or present as a singular cavernous hemangioma or malformation, which is often located in the rectosigmoid region. Misdiagnosis is common despite characteristic radiographic features such as radiolucent phleboliths on plain film imaging and a purplish nodule on endoscopy. Adjunctive imaging such as computed tomography and magnetic resonance imaging are suggested as there is potential for local invasion. Endorectal ultrasound with Doppler has also been found to be useful in some instances. Surgical resection is the mainstay of treatment, with an emphasis on sphincter preservation. Nonsurgical endoscopic treatment with banding and sclerotherapy has been reported with success, especially in instances where an extensive resection is not feasible. (Clin Colon Rectal Surg. 2011)
A recent episode of bleeding is possible. In this case, the patient presented with 2 weeks of recurrent bleeding.
Chronic recurrent bleeding is another presentation. The young patient had 10 years of recurrent bleeding. Multiple endoscopic examinations were done and the previous diagnosis was ulcerative colitis and sometimes angiodysplasia. After referral, colonoscopy and CT anigography were done.
Endoscopy 4 years go and now.
Surgery (Intersphincteric resection of rectum) was performed under the impression of diffuse cavernous hemaniogma of the rectum. Although the resection was not complete due to quality of life concerns, there has been no further bleeding until now.
Rectum, low anterior resection: Cavernous hemangiomas, diffusely distributed
1) Size: up to 4.5x3.5 cm
2) Negative proximal resection margin
- Focal involvement of distal resection margin
- Nineteen perirectal reactive lymph nodes
Followings are cases in the literatures and brief review.
Korean J Med 74:S27-S32, 2008
[References]
1) EsoTODAY - 십이지장질환 증례토의
2) SmallTODAY - 소장질환 증례토의
3) ColonTODAY - 대장질환 증례토의
4) Dr. Sinn's LiverTODAY - 간질환 증례토의
© 일원내시경교실 바른내시경연구소 이준행. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng. (2019-11-15)
