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1
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Agarwal D, Gupta S, Bhattacharjee HK, Das CJ. Imaging and interventions in vascular malformations of the gastrointestinal tract. Abdom Radiol (NY) 2025:10.1007/s00261-025-04880-5. [PMID: 40095013 DOI: 10.1007/s00261-025-04880-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Revised: 02/13/2025] [Accepted: 03/03/2025] [Indexed: 03/19/2025]
Abstract
Vascular malformations of the gastrointestinal (GI) tract are a rare yet significant cause of GI bleeding, that can present at any age and require a high index of suspicion for timely diagnosis. While the majority of lesions may be asymptomatic and detected incidentally on imaging, they may also present with anemia if there is occult blood loss, as acute GI bleeding, or as lead points for intussusception. The presence of multiple vascular malformations may be associated with underlying syndromes, such as Hereditary Hemorrhagic Telangiectasia syndrome and Klippel-Trénaunay syndrome. While luminal endoscopy is the first-line diagnostic test to evaluate overt and occult GI bleeding, imaging plays a very significant role in detecting these vascular malformations and planning the best treatment approach. In this review, we describe the various imaging findings of GI tract vascular malformations and available treatment options, focusing on endovascular interventional treatments where possible.
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Affiliation(s)
- Divij Agarwal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanchita Gupta
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Hemanga K Bhattacharjee
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Chandan J Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India.
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2
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Kővári BP, Lauwers GY. Mesenchymal Tumors of the Tubular Gastrointestinal Tract (Non-GIST): The GI Pathologist's Approach. Adv Anat Pathol 2025; 32:110-131. [PMID: 39588681 DOI: 10.1097/pap.0000000000000469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2024]
Abstract
Mesenchymal neoplasms of the gastrointestinal tract are rare compared with epithelial lesions. However, over the past few decades, the increasing volume of gastrointestinal endoscopy has expedited the recognition of several novel entities with varying clinical significance. Its spectrum extends from reactive changes and benign neoplasms to highly aggressive sarcomas. At the malignant end of the spectrum, the importance of correctly diagnosing these tumors is underscored by the specific therapeutic implications available for some tumor types (eg, tyrosine kinase inhibitors for gastrointestinal stromal tumors) that allow personalized treatments. Benign lesions frequently surface among routine polypectomy specimens, sometimes offering diagnostic challenges. However, precise classification is the only way to avoid prognostic uncertainty and overtreatment, and to recognize possible syndromic associations. Hereby, we offer a pragmatic review of the topic from the gastrointestinal pathologist's perspective, who, although more accustomed to epithelial neoplasms, can use an algorithmic approach to diagnose mesenchymal entities successfully.
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Affiliation(s)
- Bence P Kővári
- Department of Pathology, Mass General Brigham, Harvard Medical School, Boston, MA
| | - Gregory Y Lauwers
- Department of Pathology, Henry Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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3
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Chen Z, Wang L, Yu PJ. Early and accurate diagnosis and selection of appropriate treatment plans are crucial for patients with gastrointestinal hemangiomas. World J Gastrointest Surg 2025; 17:99432. [DOI: 10.4240/wjgs.v17.i2.99432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 11/15/2024] [Accepted: 12/03/2024] [Indexed: 01/22/2025] Open
Abstract
Gastrointestinal hemangioma (GIH) is clinically rare, accounting for 7%-10% of benign gastrointestinal tumors and 0.5% of systemic hemangiomas. GIH can occur as either solitary or multiple lesions, with gastrointestinal bleeding as a significant clinical manifestation. Understanding the clinical and endoscopic features of GIH is essential for improving diagnostic accuracy, particularly through endoscopy and selective arteriography, which are highly effective in diagnosing GIH and preventing misdiagnosis and inappropriate treatment. Upon confirmed diagnosis, it is essential to thoroughly evaluate the patient's condition to determine the most suitable treatment modality—whether surgical, endoscopic, or minimally invasive intervention. The minimally invasive interventional partial embolization therapy using polyvinyl alcohol particles, proposed and implemented by Pospisilova et al, has achieved excellent clinical outcomes. This approach reduces surgical trauma and the inherent risks of traditional surgical treatments.
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Affiliation(s)
- Zhou Chen
- Department of Emergency Medicine, The Second Affiliated Hospital of Guangdong University, Zhanjiang 524000, Guangdong Province, China
| | - Liang Wang
- Department of Gastrointestinal Oncology Surgery, Affiliated Hospital of Qinghai University, Xining 810000, Qinghai Province, China
| | - Peng-Jie Yu
- Department of Anorectal Surgery, The Affiliated Hospital of Qinghai University, Xining 810000, Qinghai Province, China
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4
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Tojal Ramos Dos Santos LF, Gusmão Vicente de Carvalho C, Gioia Morrell AL, Silva Franco A. Vascular Malformation in the Gastrointestinal Tract Mimicking Vasculitis: A Case Report. Cureus 2025; 17:e79814. [PMID: 40166505 PMCID: PMC11955543 DOI: 10.7759/cureus.79814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2025] [Indexed: 04/02/2025] Open
Abstract
Diagnosing vasculitis is challenging because it lacks pathognomonic signs and symptoms. Gastrointestinal vasculitis further complicates the picture, given its high mortality risk and the potential absence of systemic manifestations; thus, a systematic approach that includes ruling out vasculitis mimickers is useful. We report the case of a 29-year-old male evaluated for suspected intestinal vasculitis due to recurrent rectal bleeding, weight loss, fatigue, elevated inflammatory markers, high immunoglobulin E (IgE) levels, and positive anti-neutrophil cytoplasmic antibodies (ANCA), coupled with computed tomography (CT) showing diffuse parietal thickening of the anus, rectum, and sigmoid colon. These findings raised suspicion for eosinophilic granulomatosis with polyangiitis, prompting high-dose corticosteroid therapy before definitive diagnosis. However, contrast-enhanced magnetic resonance imaging (MRI) later revealed phleboliths and venous lakes, indicating gastrointestinal diffuse cavernous hemangioma (GDCH). Sirolimus was introduced to facilitate steroid tapering and to reduce bleeding, ultimately leading to significant lesion regression and symptom resolution. This case underscores the importance of excluding vasculitis mimickers - particularly vascular malformations - when evaluating potential gastrointestinal vasculitis.
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Affiliation(s)
| | | | | | - André Silva Franco
- Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, BRA
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5
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Zhang B, Pang HQ, Luo H. Ileal venous malformation in a pediatric patient. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:1440-1441. [PMID: 39143933 DOI: 10.1002/jcu.23786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 07/19/2024] [Accepted: 07/29/2024] [Indexed: 08/16/2024]
Abstract
A 16-month-old girl presented with ileal venous malformation. Ultrasound facilitated a preoperative diagnosis, leading to a successful surgical resection. The study emphasizes the critical role of identifying sonographic features like intestinal wall thickening, a serpiginous mass with sluggish blood sinuses, and rich vascular flow for accurate diagnosis and timely treatment.
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Affiliation(s)
- Bo Zhang
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Hou-Qing Pang
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Hong Luo
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, China
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6
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Pospisilova B, Frydrych J, Krajina A, Örhalmi J, Kajzrlikova IM, Vitek P. Anorectal hemangioma, a rare cause of lower gastrointestinal bleeding, treated with selective embolization: A case report. World J Gastrointest Surg 2024; 16:2735-2741. [PMID: 39220052 PMCID: PMC11362948 DOI: 10.4240/wjgs.v16.i8.2735] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/03/2024] [Accepted: 06/21/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Anorectal hemangioma is a rare and frequently misdiagnosed cause of lower gastrointestinal (GI) bleeding. Here, we present a minimally invasive therapy with selective embolization. CASE SUMMARY A 21-year-old male patient experienced painless rectal bleeding since childhood and was treated for ulcerative colitis. Diagnostic studies later revealed specific characteristics for vascular lesions-anorectal hemangiomas. The severity of rectal bleeding caused symptomatic anemia and possible surgical treatment was associated with a high risk of fecal incontinence. Here, we present selective embolization, a minimally invasive therapeutic approach that is proven as an alternative therapeutic method of choice. The patient significantly improved temporarily and had a small ischemic ulcer, which healed with a control colonoscopy and developed no stenosis. CONCLUSION Awareness of the clinical and radiological features of GI hemangiomas may help improve diagnostics and avoid inappropriate therapeutic procedures.
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Affiliation(s)
- Barbora Pospisilova
- Department of Internal Medicine, Hospital in Frydek-Mistek, Frydek-Mistek 73801, Czech Republic
| | - Jaromir Frydrych
- Department of Radiodiagnostic, Hospital in Jablonec nad Nisou, Jablonec nad Nisou 46601, Czech Republic
| | - Antonin Krajina
- Department of Radiology, University Hospital Hradec Kralove, Hradec Kralove 50005, Czech Republic
| | - Julius Örhalmi
- Department of Surgery, Hospital Horovice, Horovice 26831, Czech Republic
| | - Ivana M Kajzrlikova
- Department of Internal Medicine, Hospital in Frydek-Mistek, Frydek-Mistek 73801, Czech Republic
| | - Petr Vitek
- Department of Internal Medicine, Hospital in Frydek-Mistek, Frydek-Mistek 73801, Czech Republic
- Faculty of Medicine, University of Ostrava, Ostrava 70300, Czech Republic
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7
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Chen L, Chen F, Jiang T, Deng Y, Shi G. Endoscopic injection of lauromacrogol foam sclerotherapy for rectal cavernous hemangioma: A case report. Medicine (Baltimore) 2024; 103:e38919. [PMID: 38996140 PMCID: PMC11245261 DOI: 10.1097/md.0000000000038919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
RATIONALE Rectal cavernous hemangioma is a rare, benign vascular disease that seldom causes lower gastrointestinal bleeding, characterized by a high rate of misdiagnosis and missed diagnoses. Surgical treatment is considered to be relatively effective; however, it is accompanied by certain employed in the treatment of superficial hemangioma, boasting the advantages of minimally invasive surgery, including safety, effectiveness, reduced trauma, and rapid recovery. However, there is a lack of literature regarding the application of foam sclerosing agents for gastrointestinal hemangiomas. CASE CONCERNS We present a case of a 60-year-old male who was admitted to our hospital with a history of recurrent hematochezia for >1 year and worsening symptoms for 1 week. The patient's medical history was unremarkable. DIAGNOSES Following colonoscopy, nuclear magnetic resonance imaging, computed tomography, and other examinations, the final diagnosis was rectal cavernous hemangioma. INTERVENTIONS Due to the patient's refusal of surgery, endoscopic foam sclerotherapy using a lauromacrogol injection was performed after obtaining informed consent from the patient and their relatives. OUTCOMES Post-sclerotherapy, hematochezia symptoms ceased, and no adverse reactions were observed. Two months later, colonoscopy and nuclear magnetic resonance imaging showed that the hemangioma had almost completely disappeared, with only a small amount of tumor remnants, yielding a satisfactory curative effect. CONCLUSION Our findings indicate that endoscopic injection of a lauromacrogol foam sclerosing agent is a safe, effective, and minimally invasive treatment option for gastrointestinal cavernous hemangiomas.
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Affiliation(s)
- Ling Chen
- Department of Gastroenterology, Digestive Disease Hospital, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China
| | - FengYu Chen
- Fenggang County People’s Hospital , Fenggang, Guizhou Province, China
| | - Tong Jiang
- Department of Gastroenterology, Digestive Disease Hospital, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China
| | - Yue Deng
- Department of Gastroenterology, Digestive Disease Hospital, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China
| | - GuoQing Shi
- Department of Gastroenterology, Digestive Disease Hospital, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China
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8
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Zhu HT, Chen WG, Wang JJ, Guo JN, Zhang FM, Xu GQ, Chen HT. Endoscopic ultrasound-guided lauromacrogol injection for treatment of colorectal cavernous hemangioma: Two case reports. World J Gastrointest Surg 2024; 16:966-973. [PMID: 38577088 PMCID: PMC10989353 DOI: 10.4240/wjgs.v16.i3.966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/20/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Colorectal cavernous hemangioma is a rare vascular malformation resulting in recurrent lower gastrointestinal hemorrhage, and can be misinterpreted as colitis. Surgical resection is currently the mainstay of treatment, with an emphasis on sphincter preservation. CASE SUMMARY We present details of two young patients with a history of persistent hematochezia diagnosed with colorectal cavernous hemangioma by endoscopic ultrasound (EUS). Cavernous hemangioma was relieved by several EUS-guided lauromacrogol injections and the patients achieved favorable clinical prognosis. CONCLUSION Multiple sequential EUS-guided injections of lauromacrogol is a safe, effective, cost-efficient, and minimally invasive alternative for colorectal cavernous hemangioma.
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Affiliation(s)
- Hua-Tuo Zhu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Wen-Guo Chen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Jing-Jie Wang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Jia-Nan Guo
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Fen-Ming Zhang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Guo-Qiang Xu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Hong-Tan Chen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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9
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Vlad RM, Dobritoiu R, Niculescu C, Moga A, Balanescu L, Pacurar D. From Severe Anemia to Intestinal Hemangiomatosis, a Bumpy Road-A Case Report and Literature Review. Diagnostics (Basel) 2024; 14:310. [PMID: 38337828 PMCID: PMC10855473 DOI: 10.3390/diagnostics14030310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
Gastrointestinal hemangiomas (GIH) are unusual vascular tumors found anywhere alongside the GI tract, the small bowel being the most common site. Diagnosis requires good clinical insight and modern imaging. This is a comprehensive review of the literature, starting from a new pediatric case diagnosed through exploratory laparotomy after complex imaging techniques failed. This research was conducted on published articles from the past 25 years. We identified seventeen original papers (two series of cases with three and two patients, respectively, and fifteen case reports). The female/male ratio was 1.5. The youngest patient was a 3-week-old boy, and the was oldest a 17-year-old girl. The most common localization was the jejunum (eight cases), followed by the ileum (four), colon (three), stomach (two), and rectum (one). Seven children had cavernous and four had capillary hemangiomas. Eight patients presented gastrointestinal bleeding, seven had refractory anemia, such as our index patient, three had recurrent abdominal pain, and two had bowel obstruction. Surgical assessment was successful in fifteen cases; three cases experienced great outcomes with oral propranolol, one child was treated successfully with sirolimus, and for one patient, endoscopic treatment was the best choice. The authors present the case of a female patient admitted to the Pediatrics Department of "Grigore Alexandrescu" Emergency Children's Hospital from 25 February to 28 March 2019 for severe anemia, refractory to oral iron treatment, and recurrent blood infusions. No clear bleeding cause had been found. Although very uncommon, intestinal hemangiomas can express puzzling, life-threatening symptoms. We should keep in mind this disorder in cases of unresponsive chronic anemia.
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Affiliation(s)
- Raluca Maria Vlad
- “Grigore Alexandrescu” Emergency Children’s Hospital, 011743 Bucharest, Romania; (R.D.); (A.M.); (L.B.); (D.P.)
- Department of General Medicine, Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ruxandra Dobritoiu
- “Grigore Alexandrescu” Emergency Children’s Hospital, 011743 Bucharest, Romania; (R.D.); (A.M.); (L.B.); (D.P.)
| | | | - Andreea Moga
- “Grigore Alexandrescu” Emergency Children’s Hospital, 011743 Bucharest, Romania; (R.D.); (A.M.); (L.B.); (D.P.)
- Department of General Medicine, Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Laura Balanescu
- “Grigore Alexandrescu” Emergency Children’s Hospital, 011743 Bucharest, Romania; (R.D.); (A.M.); (L.B.); (D.P.)
- Department of General Medicine, Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Daniela Pacurar
- “Grigore Alexandrescu” Emergency Children’s Hospital, 011743 Bucharest, Romania; (R.D.); (A.M.); (L.B.); (D.P.)
- Department of General Medicine, Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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10
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Al-Khater N, Mohamed M, Juma A, Abubaker F, Ansari S. Endoscopic Resection of a Cavernous Hemangioma in the Sigmoid Colon: A Case Report. GASTRO HEP ADVANCES 2023; 3:396-398. [PMID: 39131147 PMCID: PMC11308848 DOI: 10.1016/j.gastha.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 08/13/2024]
Abstract
Hemangiomas in the gastrointestinal tract are extremely rare, benign vascular tumors, known for their associated complication of bleeding. They are usually difficult to diagnose, despite the characteristic definition of radiolucent phleboliths on radiology and purplish, tannish brown nodule or polyp on endoscopy. Surgical resection is the treatment of choice. We describe a rare case of sigmoid colon cavernous hemangioma in a 49-year-old male who underwent colonoscopy for lower abdominal pain and revealed a large pedunculated polyp in the sigmoid colon measuring 1.7 cm in diameter. The hemangioma was completely resected endoscopically via hot snare with a favorable outcome.
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Affiliation(s)
- Noora Al-Khater
- Internal Medicine Department, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Mohamed Mohamed
- Internal Medicine Department, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Afra Juma
- Internal Medicine Department, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Faisal Abubaker
- Gastroenterology and Hepatology Department, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Sameer Ansari
- Pathology Department, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
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11
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Gallagher J, Quach B, Sempokuya T, Sivaraman A. A Unique Presentation of Familial Idiopathic Colonic Varices. ACG Case Rep J 2023; 10:e01185. [PMID: 37928226 PMCID: PMC10621910 DOI: 10.14309/crj.0000000000001185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023] Open
Abstract
Colonic varices typically occur in the setting of portal hypertension, and patients may present with rectal bleeding or occult anemia. Idiopathic colonic varices occur infrequently in the absence of cirrhosis and can involve the entire colon. We present a case of a 54-year-old Eastern European woman who had undergone diagnostic colonoscopy for newly diagnosed sigmoid adenocarcinoma and was incidentally found to have colonic varices with normal portal pressure gradients. Her 38-year-old daughter was found to have similar varices, raising concerns for hereditary etiology.
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Affiliation(s)
- John Gallagher
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Bill Quach
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Tomoki Sempokuya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Anita Sivaraman
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
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12
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Schabl L, Connelly T, Steele S, Kessler H. Giant rectal vascular malformation: a rare differential diagnosis in rectal bleeding. BMJ Case Rep 2023; 16:e256038. [PMID: 37770238 PMCID: PMC10546121 DOI: 10.1136/bcr-2023-256038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Investigations in a woman with prolonged symptoms of laxative-resistant constipation and recurrent rectal bleeding revealed a giant rectal vascular malformation. Colonoscopy and MRI were performed to rule out malignancy and determine differential diagnoses. Repeated tests were necessary due to inconclusive results. After a definite diagnosis, image-guided, transcutaneously administered sclerotherapy was used. The intervention and postoperative course were uneventful. A minimally invasive procedure relieved symptoms and improved quality of life.
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Affiliation(s)
- Lukas Schabl
- Department of Colorectal Surgery, Cleveland Clinic Main Campus Hospital, Cleveland, Ohio, USA
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tara Connelly
- Department of Pediatric Surgery, King's College Hospital, London, UK
| | - Scott Steele
- Department of Colorectal Surgery, Cleveland Clinic Main Campus Hospital, Cleveland, Ohio, USA
| | - Hermann Kessler
- Department of Colorectal Surgery, Cleveland Clinic Main Campus Hospital, Cleveland, Ohio, USA
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13
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Petruhina J, Pukite I, Briuka I, Abola Z, Melderis I. Young ESPGHAN Members Image of the Month: Sigmoid Hemangioma as a Cause of Rectal Bleeding in Infant. J Pediatr Gastroenterol Nutr 2023; 76:e81. [PMID: 36515676 DOI: 10.1097/mpg.0000000000003681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jevgenija Petruhina
- From the Department of Pediatric Endoscopy, Children's Clinical University Hospital, Riga, Latvia
| | - Ieva Pukite
- the Department of Pediatric Gastroenterology, Children's Clinical University Hospital, Riga, Latvia
| | - Ilze Briuka
- From the Department of Pediatric Endoscopy, Children's Clinical University Hospital, Riga, Latvia
| | - Zane Abola
- the Department of Pediatric Surgery, Children's Clinical University Hospital, Riga, Latvia
| | - Ivars Melderis
- the Department of Pathology, Children's Clinical University Hospital, Riga, Latvia
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14
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Zahroodi HS, Monazzami M, Dehghanian P, Ameri L, Taqanaki PB, Mashhadi MP. Small bowel hemangioma causing perforation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023; 90:102581. [DOI: 10.1016/j.epsc.2023.102581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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15
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Jha AK, Suchismita A, Dayal VM. Large Anorectal Venous Malformation Treated With Microfoam Therapy. ACG Case Rep J 2023; 10:e01015. [PMID: 37021280 PMCID: PMC10069833 DOI: 10.14309/crj.0000000000001015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/21/2023] [Indexed: 04/03/2023] Open
Abstract
Deficiency of smooth muscle cells can lead to dysfunction and engorgement of blood vessels termed as hemangioma, arteriovenous malformations, and venous malformations (VMs). Anorectal VM is a rare disease. It can present with massive hematochezia. An optimal treatment of anorectal VMs has not been defined. Surgery is an option if the lesion can be resected completely. Endoscopic injection sclerotherapy has been reported to be effective in treating small colorectal VMs. However, it has rarely been described in the treatment of large VMs. In this study, we describe a rare case of large anorectal VMs treated with microfoam sclerotherapy.
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Affiliation(s)
- Ashish Kumar Jha
- Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, India
| | - Arya Suchismita
- Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, India
| | - Vishwa Mohan Dayal
- Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, India
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16
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Erdemli S, Alis D, Çiçek B, Göksel S, Karahasanoğlu T, Karaarslan E. Revisiting imaging features of rectosigmoid vascular malformation with emphasis on multiparametric MRI: a case report. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Gastrointestinal vascular malformations are rare benign vascular neoplasms of the gastrointestinal tract, with the rectosigmoid region being the most frequently involved site. Patients often manifest with recurrent, intermittent rectal bleeding, which might occasionally be life-threatening.
Case presentation
A 39-year-old man with a history of hemorrhoid operations twice was presented to our gastroenterology department with blood in the stool and abdominal pain. After the colonoscopy, multiparametric MRI, and CT examinations, robotic low anterior resection was performed with the diagnosis of rectosigmoid venous malformation. The histopathological examination confirmed the diagnosis.
Conclusion
Colonoscopy is the preferred method in diagnosing rectosigmoid vascular malformation, but wrong and delayed diagnoses are common. Thus, imaging modalities might add to colonoscopy in equivocal cases.
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17
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Chandel K, Jain R, Bhatia A, Saxena AK, Sodhi KS. Bleeding per rectum in pediatric population: A pictorial review. World J Clin Pediatr 2022; 11:270-288. [PMID: 35663002 PMCID: PMC9134156 DOI: 10.5409/wjcp.v11.i3.270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/09/2021] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
Bleeding per rectum in children can be seen in congenital as well as acquired conditions that may require medical or surgical management. The present review article is aimed to discuss the imaging findings of some common and uncommon causes of bleeding per rectum in children.
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Affiliation(s)
- Karamvir Chandel
- Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rishabh Jain
- Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Anmol Bhatia
- Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Akshay Kumar Saxena
- Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Kushaljit Singh Sodhi
- Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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18
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Chandel K, Jain R, Bhatia A, Saxena AK, Sodhi KS. Bleeding per rectum in pediatric population: A pictorial review. World J Clin Pediatr 2022; 11:271-289. [DOI: 10.5409/wjcp.v11.i3.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Bleeding per rectum in children can be seen in congenital as well as acquired conditions that may require medical or surgical management. The present review article is aimed to discuss the imaging findings of some common and uncommon causes of bleeding per rectum in children.
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Affiliation(s)
- Karamvir Chandel
- Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rishabh Jain
- Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Anmol Bhatia
- Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Akshay Kumar Saxena
- Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Kushaljit Singh Sodhi
- Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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19
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Liu WP, Lu Y, Liu W. Gastrointestinal Bleeding Due to Arteriovenous Malformation of The Intestine. Am J Med Sci 2021; 362:e49-e50. [PMID: 34077705 DOI: 10.1016/j.amjms.2021.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/01/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Wei-Peng Liu
- Institute of Digestive Disease, China Three Gorges University, Yichang, China; Department of Gastrointestinal Surgery, Yichang Central People's Hospital, Yichang, China
| | - Yuan Lu
- Institute of Digestive Disease, China Three Gorges University, Yichang, China; Department of Gastrointestinal Surgery, Yichang Central People's Hospital, Yichang, China
| | - Wei Liu
- Institute of Digestive Disease, China Three Gorges University, Yichang, China; Department of Gastrointestinal Surgery, Yichang Central People's Hospital, Yichang, China.
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20
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Isolated Diffuse Cavernous Hemangioma of the Appendix with Acute Appendicitis. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02648-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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21
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Cura‐Esquivel I, Velasquez‐Palacios C, Núñez‐Ku M. Gastrointestinal infantile hemangioma: A rare cause of digestive tract bleeding in children to consider. Clin Case Rep 2021; 9:e04722. [PMID: 34504695 PMCID: PMC8418681 DOI: 10.1002/ccr3.4722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/14/2021] [Accepted: 07/24/2021] [Indexed: 11/09/2022] Open
Abstract
Intestinal hemangiomas are an infrequent cause of gastrointestinal bleeding and chronic anemia in infants, which diagnosis depends on high suspicion. Propranolol has been described as an effective treatment.
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Affiliation(s)
- Idalia Cura‐Esquivel
- Pediatric Department of the University Hospital “Dr. José Eleuterio González”MonterreyMéxico
| | | | - Madeline Núñez‐Ku
- Pediatric Department of the University Hospital “Dr. José Eleuterio González”MonterreyMéxico
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22
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Mascarenhas M, Morais R, Teixeira R, Macedo G. An Unexpected Colonic Polyp: Cavernous Hemangioma. Ann Coloproctol 2021:ac.2020.00535.0076. [PMID: 34256425 DOI: 10.3393/ac.2020.00535.0076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 05/09/2021] [Indexed: 10/20/2022] Open
Abstract
Cavernous hemangiomas of the colon are rare, benign vascular lesions, and the site most commonly affected is the rectosigmoid junction. Surgical treatment is recommended for large diffuse lesions but in the presence of pedunculated lesions, endoscopic resection should be preferred if possible. We report a case of a 65-year-old man referred for colonoscopy after positive fecal occult blood, that revealed at the level of the sigmoid colon, a wide base pedunculated polyp (35 mm) occupying more than half of the lumen, with the covering mucosa with a vinous appearance. In order to remove the lesion, a detachable snare was placed and polypectomy was performed. During the procedure, the detachable snare was cut with active bleeding, controlled after clip placement and diluted adrenaline injection. Afterwards, histology revealed a polypoid lesion with a hyperplastic mucosa and submucosal plane expanded by numerous thick-walled vessels in the context of a cavernous colonic hemangioma.
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Affiliation(s)
- Miguel Mascarenhas
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | - Rui Morais
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | - Regina Teixeira
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
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23
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Peng C, Tan SS, Pang W, Wang Z, Wu D, Wang K, Chen Y. Vascular Malformation of the Colorectum in Children: Case Series of 27 Patients. World J Surg 2021; 45:3214-3221. [PMID: 34189620 DOI: 10.1007/s00268-021-06221-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Vascular malformation of the colorectum is a rare disease that presents most commonly in early childhood. Some pull-through procedures have been performed for its treatment. However, laparotomy was routinely required. The aim of this study was to present features of this disease, as well as the outcomes of transanal endorectal pull-through (TEPT) with or without laparotomy. METHODS A retrospective analysis was performed on consecutive patients with vascular malformation of the colorectum who underwent TEPT with or without laparotomy in our hospital between January 2010 and December 2019. Follow-up information included hematochezia, other bleeding and bowel function. Bowel function was assessed using the Rintala score. RESULTS Twenty-seven patients were included (14 boys and 13 girls). Hematochezia and anemia were the main chief complaints. Perianal vasodilatation and prolapse of rectal mucosa with spurting blood were detected in 13 (48.1%) and 9 (33.3%), respectively. Eighteen patients (66.7%) underwent TEPT with laparotomy, and 9 patients underwent TEPT without laparotomy (including 5 TEPT under laparoscopic supervision) for lesions located beyond the distal sigmoid colon. Compared to TEPT with laparotomy, the length of resected bowel and operative time was significantly shorter in TEPT without laparotomy (p = 0.001 and p = 0.004). There was no statistical difference for intraoperative blood loss. Other vascular malformations were detected in 9 patients (33.3%); 3 were detected by laparoscopy. Three patients (11.1%) experienced postoperative complications. Follow-up was held with 24 patients (3 were lost to follow-up). The mean follow-up time was 51.9 ± 32.8 months. Four patients occasionally had bloody stools, without anemia. None had hematuria or vaginal bleeding. Median bowel function score was 20 (range 17-20). CONCLUSION Hematochezia, anemia and hemorrhoid-like manifestations might be an indication for vascular malformation of the colorectum in children. TEPT was effective for vascular malformation of the colorectum, and TEPT without laparotomy was more suitable for the short lesions.
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Affiliation(s)
- Chunhui Peng
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 of Nanlishi Road, Xicheng, Beijing, 100045, China
| | - Sarah Siyin Tan
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 of Nanlishi Road, Xicheng, Beijing, 100045, China
| | - Wenbo Pang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 of Nanlishi Road, Xicheng, Beijing, 100045, China
| | - Zengmeng Wang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 of Nanlishi Road, Xicheng, Beijing, 100045, China
| | - Dongyang Wu
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 of Nanlishi Road, Xicheng, Beijing, 100045, China
| | - Kai Wang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 of Nanlishi Road, Xicheng, Beijing, 100045, China
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 of Nanlishi Road, Xicheng, Beijing, 100045, China.
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24
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Brill R, Goldann C, Walldorf J, Messmann H, Brill E, Uller W, Michl P, Wildgruber M, Wohlgemuth WA, Rosendahl J. Fluoroscopy-guided endoscopic sclerotherapy: a novel hybrid approach for symptomatic rectosigmoidal venous malformation (with video). Gastrointest Endosc 2021; 93:496-502. [PMID: 32553568 DOI: 10.1016/j.gie.2020.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Recommendations for the treatment of lower GI bleeding do not include bleeding from venous malformations (VMs). The aim of this study was to delineate the usefulness of a novel hybrid intervention (fluoroscopy-guided endoscopic sclerotherapy) for the treatment of symptomatic VMs in the rectosigmoidal colon with bleeding. METHODS The magnetic resonance images of 421 patients with VM, referred to multicenter vascular anomaly centers from 2009 to 2017, were analyzed retrospectively. Treatment was performed for all patients who experienced bleeding from rectosigmoidal VMs using fluoroscopy-guided endoscopic sclerotherapy with polidocanol foam as a novel approach. RESULTS A total of 27 patients displayed VM in the rectosigmoidal area. Eleven of these presented with acute or previous bleeding and received treatment. Active bleeding was observed in 8 patients (72.7%), whereas 3 patients (27.3%) had signs of previous bleeding. Six of the 11 patients had anemia (54.5%). There were no adverse events within 24 hours of the intervention. In a 2-year follow-up period, only 1 patient (9.1%) presented with recurrent bleeding after 13 months and was successfully treated again with fluoroscopy-guided endoscopic sclerotherapy. CONCLUSIONS Fluoroscopy-guided endoscopic sclerotherapy was shown to be a safe and effective treatment of symptomatic VMs of the rectosigmoidal area. Thus, fluoroscopy-guided endoscopic sclerotherapy should be considered for patients with bleeding from VMs of the rectosigmoid after a comprehensive workup and interdisciplinary case discussion.
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Affiliation(s)
- Richard Brill
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Constantin Goldann
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jens Walldorf
- Department of Internal Medicine I, Martin Luther University, Halle (Saale), Germany
| | - Helmut Messmann
- III Medizinische Klinik, University Clinic Augsburg, Augsburg, Germany
| | - Eva Brill
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Wibke Uller
- Department of Radiology, University Medical Center, Regensburg, Germany
| | - Patrick Michl
- Department of Internal Medicine I, Martin Luther University, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital Ludwig-Maximilians-Universität, Campus Großhadern, Munich, Germany
| | - Walter A Wohlgemuth
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jonas Rosendahl
- Department of Internal Medicine I, Martin Luther University, Halle (Saale), Germany
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25
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Numan L, Elkafrawy A, Brotherton T, Tomaw A, Campbell D. Jejunal Submucosal Hemangioma as a Cause of Massive Gastrointestinal Bleeding: A Case Report. Cureus 2020; 12:e8372. [PMID: 32626616 PMCID: PMC7328703 DOI: 10.7759/cureus.8372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/31/2020] [Indexed: 12/05/2022] Open
Abstract
Small intestinal hemangiomas are uncommon tumors that frequently present with gastrointestinal bleeding (GIB). Diagnosis, detection, and treatment can be challenging and may require surgical intervention. An 81-year-old female presented with melena. Video capsule endoscopy revealed active bleeding in the proximal jejunum and push enteroscopy identified a polypoid nodule with central umbilication. The patient underwent laparoscopic resection and jejunal submucosal hemangioma was detected. Submucosal hemangiomas are a rare cause of GIB. As the most common site of submucosal hemangiomas is the mid-jejunum, they are not easy to detect. Surgical intervention is usually required for a definitive diagnosis and definitive treatment.
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Affiliation(s)
- Laith Numan
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Ahmed Elkafrawy
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Tim Brotherton
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Andrew Tomaw
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Donald Campbell
- Gastroenterology, University of Missouri Kansas City and Saint Luke's Hospital, Kansas City, USA
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26
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Fu JX, Zou YN, Han ZH, Yu H, Wang XJ. Small bowel racemose hemangioma complicated with obstruction and chronic anemia: A case report and review of literature. World J Gastroenterol 2020; 26:1674-1682. [PMID: 32327915 PMCID: PMC7167414 DOI: 10.3748/wjg.v26.i14.1674] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal hemangiomas are rare benign tumors. According to the size of the affected vessels, hemangiomas are histologically classified into cavernous, capillary, or mixed-type tumors, with the cavernous type being the most common and racemose hemangiomas being very rare in the clinic. Melena of uncertain origin and anemia are the main clinical manifestations, and other presentations are rare. Due to the rarity of gastrointestinal hemangiomas and lack of specific manifestations and diagnostic methods, preoperative diagnoses are often delayed or incorrect.
CASE SUMMARY We report a 5-year-old girl who presented with abdominal pain, nausea, and vomiting for a duration of 10 h. The laboratory studies showed prominent anemia. Computed tomography and contrast-enhanced computed tomography of the abdomen revealed a small bowel obstruction caused by a giant abdominal mass. Segmental resection of the ileal lesions was performed through surgery, and the final pathology results revealed a diagnosis of racemose hemangioma complicated by a small bowel obstruction and simultaneous chronic anemia.
CONCLUSION The current report will increase the understanding of the diagnosis and treatment of gastrointestinal hemangiomas and provide a review of the related literature.
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Affiliation(s)
- Ji-Xin Fu
- Department of Gastrointestinal Surgery, Weihai Central Hospital, Weihai 264200, Shandong Province, China
| | - Ya-Nan Zou
- Department of Anesthesiology, Weihai Central Hospital, Weihai 264200, Shandong Province, China
| | - Zhi-Hao Han
- Department of Radiology, Weihai Central Hospital, Weihai 264200, Shandong Province, China
| | - Hao Yu
- Department of Gastrointestinal Surgery, Weihai Central Hospital, Weihai 264200, Shandong Province, China
| | - Xin-Jian Wang
- Department of Gastrointestinal Surgery, Weihai Central Hospital, Weihai 264200, Shandong Province, China
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27
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Cotzias E, Rehman SF, Arsalani Zadeh R, Smith D. Conservative management of diffuse cavernous haemangioma of the sigmoid and rectum. Ann R Coll Surg Engl 2020; 102:e1-e3. [PMID: 31155921 PMCID: PMC6937611 DOI: 10.1308/rcsann.2019.0088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2019] [Indexed: 11/22/2022] Open
Abstract
Diffuse cavernous haemangioma is a rare disease of the rectum. It usually presents with a history of rectal bleeding in children and young adults. When conservative methods fail to control bleeding, traditionally resection is recommended. A 50-year-old man presented with per rectal bleeding and was diagnosed with diffuse cavernous haemangioma of the sigmoid and rectum extending up to 40 cm in the left colon through endoscopy, magnetic resonance imaging and computed tomography. The diagnosis was confirmed by biopsy. This patient was successful managed conservatively with tranexamic acid as needed, avoiding the need for resection.
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Affiliation(s)
- E Cotzias
- Royal Bolton Hospital NHS Foundation Trust, Bolton, UK
| | - SF Rehman
- Royal Bolton Hospital NHS Foundation Trust, Bolton, UK
| | | | - D Smith
- Royal Bolton Hospital NHS Foundation Trust, Bolton, UK
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28
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Rectosigmoidal manifestations of venous malformations: MR imaging findings and interdisciplinary therapeutic modalities. Sci Rep 2019; 9:19916. [PMID: 31882623 PMCID: PMC6934467 DOI: 10.1038/s41598-019-56217-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 12/06/2019] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to identify the frequency of rectosigmoidal involvement in patients with venous malformations (VM) of the lower extremities and to demonstrate multidisciplinary therapeutic options. The medical records and magnetic resonance images (MRI) of patients with VM of the lower extremities, over a six-year period, were reviewed retrospectively in order to determine the occurrence of rectosigmoidal involvement. Vascular interventions, surgical treatments, percutaneous and hybrid (endoscopy-guided angiography) sclerotherapy and procedural complications (according to Clavien-Dindo classification) were also noted. Of the 378 patients with vascular malformation of the lower limbs, 19 patients (5%) had documented venous rectosigmoidal malformation. All of these 19 patients reported episodes of rectal bleeding, while seven patients (36.8%) also had anemia. All patients underwent endoscopy. By endoscopy, seven patients (36.8%) showed discreet changes, and 12 patients (63.2%) showed pronounced signs of submucosal VM with active (47.3%) or previous (15.7%) bleeding. Treatment was performed in all patients with pronounced findings. Six patients underwent endoscopy-guided hybrid sclerotherapy, one patient underwent endoscopic tissue removal, one patient received percutaneous sclerotherapy and one patient received a combination of transvenous embolization and hybrid sclerotherapy. Three patients required open surgery. No complications occurred after conservative treatments; however, one complication was reported after open surgery. None of the treated patients reported further bleeding and anemia at the end of the follow-up period. In this cohort, rectosigmoidal VM occurred in 5% of patients presenting with a high incidence of rectal bleeding. Percutaneous or endoscopy-guided hybrid sclerotherapy appeared to be a safe and effective alternative to surgery.
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29
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Bates DDB, de Paula MCF, Horvat N, Sheedy S, Lall C, Kassam Z, Pickhardt P, Lalwani N, Ganeshan D, Petkovska I. Beyond adenocarcinoma: MRI of uncommon rectal neoplasms and mimickers. Abdom Radiol (NY) 2019; 44:3581-3594. [PMID: 31069482 PMCID: PMC7386089 DOI: 10.1007/s00261-019-02045-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To provide a review of rare rectal tumors beyond adenocarcinoma. RESULTS Rectal cancer is a common malignancy, both in the United States and abroad. In addition to adenocarcinoma, abdominal radiologists will encounter a variety of other less common rectal masses, both benign and malignant neoplasms as well as non-neoplastic mimickers. Familiarity with these conditions and their characteristic features on MRI is useful in clinical practice. In this article, a number of such conditions are discussed, with an emphasis on distinguishing features on MRI of the rectum. CONCLUSION Familiarity with the MRI features of rare rectal tumors beyond adenocarcinoma, as well as a small number of non-neoplastic mimics, is important for abdominal imagers to make diagnostic differentials and to assist in treatment planning.
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Affiliation(s)
- David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
| | | | - Natally Horvat
- Department of Radiology, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Shannon Sheedy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Chandana Lall
- Department of Radiology, University of Florida, Jacksonville, FL, USA
| | - Zahra Kassam
- Department of Medical Imaging, University of Western Ontario, London, ON, Canada
| | - Perry Pickhardt
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Neeraj Lalwani
- Department of Radiology, Wake Forest University and Baptist Health, Winston-Salem, NC, USA
| | | | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
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30
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Ganesananthan S, Barlow J, Durai D, Hawthorne AB. Multiple venous malformations in the left colon and rectum: a long-standing case managed conservatively and an update of current literature. BMJ Case Rep 2019; 12:e227700. [PMID: 30902841 PMCID: PMC6453398 DOI: 10.1136/bcr-2018-227700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2019] [Indexed: 12/15/2022] Open
Abstract
Venous or cavernous malformations of the colon or rectum are a rare cause of lower gastrointestinal bleeds. It has been previously described as a diffuse cavernous haemangioma which was thought to be a benign vascular tumour. It mainly affects the rectosigmoid area of the gastrointestinal tract and is most common in children and young adults. Misdiagnosis is common with patients averaging a total of 19 years delay to this final diagnosis. We report a case of a 65-year-old patient who presented with occult, painless rectal bleeding and prior to this presentation, had been managed variously as colitis and angiodysplasia. This article aims to delineate the updated classification of this disease, principal clinical clues to aid the diagnosis while discussing patient treatment options and potential challenges faced in patient management.
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31
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Ocampo Toro WA, Corral Ramos B, Concejo Iglesias P, Cubero Carralero J, Blanco García DF, Barón Ródiz P. Haemangiomas of the Small Intestine: Poorly Known Cause of Gastrointestinal Bleeding of Uncertain Origin. Cureus 2018; 10:e3155. [PMID: 30349762 PMCID: PMC6193570 DOI: 10.7759/cureus.3155] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Small bowel haemangiomas are benign vascular tumours that may cause gastrointestinal bleeding of uncertain origin, are frequently chronic, and are rarely acute. We report a case of an haemangioma located in the distal ileum of a 29-year-old male with a history of chronic anemia since childhood. Imaging studies showed a mural thickening in the distal ileum with phleboliths, which is a key finding of haemangioma. Surgery was performed, and histology confirmed the diagnosis.
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32
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Martínez-Sapiña Llanas M, Otero Muinelo S, Crespo García C. TC rectal pathology: Findings at CT-colonography. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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33
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Affiliation(s)
- Tao Shi
- Department of Pathology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Li-Tian Wang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Gang Liu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
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34
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TC Rectal Pathology: Findings at CT-Colonography. RADIOLOGIA 2017; 60:208-216. [PMID: 29169607 DOI: 10.1016/j.rx.2017.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/14/2017] [Accepted: 10/19/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To review the spectrum of benign and malignant rectal diseases, their findings on CT colonography, and their management. CONCLUSION Although CT colonography is not the first choice for the study of rectal disease, it is indicated in cases where optical colonoscopy is contraindicated or cannot be completed. Rectal lesions can go undetected because this anatomic area is difficult to evaluate; for this reason, it is essential to ensure optimal preparation and distension, moderate balloon insufflation, and careful 2D and 3D navigation with knowledge of the spectrum of rectal disease and its CT colonography signs.
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Ghartimagar D, Ghosh A, Shrestha MK, Timilsina BD, Thapa S, Talwar O. Diffuse vascular malformation of large intestine clinically and radiologically misdiagnosed as ulcerative colitis. J Surg Case Rep 2017; 2017:rjx016. [PMID: 28458826 PMCID: PMC5400486 DOI: 10.1093/jscr/rjx016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/07/2017] [Indexed: 11/12/2022] Open
Abstract
Hemangiomas and vascular malformations of the gastrointestinal tract are rare clinical entities that usually present as overt or occult bleeding. They can be distributed throughout the gastrointestinal system, or present as a singular cavernous hemangioma. Overall, 80% of such malformations are of cavernous subtype and are misdiagnosed as hemorrhoids and ulcerative colitis. Mucosal edema, nodularity and vascular congestion can lead to the incorrect diagnosis of inflammatory bowel disease. We present a case of 26-year-old male who presented with pain abdomen, bleeding per rectum and was treated as a case of ulcerative colitis for past 12 years on the basis of clinical and radiological features. As the patient did not respond, subtotal colectomy was done which on histopathologically reported as cavernous vascular malformation—diffuse infiltrating (expansive type).
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Affiliation(s)
- Dilasma Ghartimagar
- Department of Pathology, Manipal College of Medical Sciences, Pokhara 61, Nepal
| | - Arnab Ghosh
- Department of Pathology, Manipal College of Medical Sciences, Pokhara 61, Nepal
| | | | | | - Sushma Thapa
- Department of Pathology, Manipal College of Medical Sciences, Pokhara 61, Nepal
| | - Op Talwar
- Department of Pathology, Manipal College of Medical Sciences, Pokhara 61, Nepal
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Yu MH, Kim YJ, Park HS, Jung SI, Jeon HJ. Imaging Patterns of Intratumoral Calcification in the Abdominopelvic Cavity. Korean J Radiol 2017; 18:323-335. [PMID: 28246512 PMCID: PMC5313520 DOI: 10.3348/kjr.2017.18.2.323] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/20/2016] [Indexed: 12/12/2022] Open
Abstract
Intratumoral calcification is one of the most noticeable of radiologic findings. It facilitates detection and provides information important for correctly diagnosing tumors. In the abdominopelvic cavity, a wide variety of tumors have calcifications with various imaging features, though the majority of such calcifications are dystrophic in nature. In this article, we classify the imaging patterns of intratumoral calcification according to number, location, and morphology. Then, we describe commonly-encountered abdominopelvic tumors containing typical calcification patterns, focusing on their differentiable characteristics using the imaging patterns of intratumoral calcification.
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Affiliation(s)
- Mi Hye Yu
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Hee Sun Park
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Hae Jeong Jeon
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
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A case of diffuse cavernous hemangioma of the appendix: laparoscopic surgery can facilitate diagnosis and treatment. Surg Case Rep 2017; 3:5. [PMID: 28054281 PMCID: PMC5214963 DOI: 10.1186/s40792-016-0276-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/08/2016] [Indexed: 12/20/2022] Open
Abstract
Background A cavenous hemangioma of the appendix (CHA) is rare. The clinical pathophysiology and adequate management of a CHA have not been sufficiently explained since reports on CHA are scarce. Case presentation A 56-year-old woman presented with chronic right lower quadrant pain. Abdominal contrast-enhanced computed tomography revealed a thickened appendix (1.5 cm in diameter) and some focal calcifications in the appendiceal wall. No acute inflammatory signs were visible around the appendix. For diagnosis and treatment, we performed a laparoscopic surgery. Intraoperative findings included purple granular lesions that were spread diffusely along the surface of the appendix. Since these lesions were spread to the terminal ileum, laparoscopic ileocecal resection was performed. Upon macroscopic inspection, purple-colored, raspberry-like lesions were found diffusely on the serosal surface of the appendix. No lesions were found on the mucosal surface. Hematoxylin and eosin staining indicated the presence of blood-filled sinus-like spaces largely in the subserosal layer. Immunohistochemistry analysis indicated that CD34-positive cells lined these spaces. Given these findings, we diagnosed the patient with a diffuse cavernous vascular malformation of the appendix. Conclusions CHA is difficult to diagnose. A laparoscopic approach may be useful for both the diagnosis and treatment of the disease.
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Colonic hemangioma, a diagnostic challenge in young adults with lower gastrointestinal tract bleeding. FORMOSAN JOURNAL OF SURGERY 2016. [DOI: 10.1016/j.fjs.2016.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Calle C, Pentsch A, Langner C. Mass-forming venous malformation of the cecum. Dig Endosc 2016; 28:755. [PMID: 27413003 DOI: 10.1111/den.12695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 06/30/2016] [Accepted: 07/05/2016] [Indexed: 02/08/2023]
Affiliation(s)
- Catarina Calle
- Institute of Pathology, Portuguese Institute of Oncology of Lisbon Francisco Gentil, Lisbon, Portugal.,Institute of Pathology, Medical University, Graz, Austria
| | - Andreas Pentsch
- Department of Surgery, Johannes Kepler University, Linz, Austria
| | - Cord Langner
- Institute of Pathology, Medical University, Graz, Austria
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Kumar N, Adam SZ, Goodhartz LA, Hoff FL, Lo AA, Miller FH. Beyond hepatic hemangiomas: the diverse appearances of gastrointestinal and genitourinary hemangiomas. ACTA ACUST UNITED AC 2016; 40:3313-29. [PMID: 26239397 DOI: 10.1007/s00261-015-0515-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hemangiomas are common lesions, best known for their appearance in the liver. Their appearance in less common locations, such as the gastrointestinal and genitourinary tracts, is less well known. We will review the typical and atypical appearance of hemangiomas in these locations on sonography, CT, and MRI.
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Affiliation(s)
- Nishant Kumar
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair St. Suite 800, Chicago, USA
| | - Sharon Z Adam
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair St. Suite 800, Chicago, USA
| | - Lori A Goodhartz
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair St. Suite 800, Chicago, USA
| | - Frederick L Hoff
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair St. Suite 800, Chicago, USA
| | - Amy A Lo
- Department of Pathology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair St. Suite 800, Chicago, USA.
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Gómez-Galán S, Mosquera-Paz MS, Ceballos J, Cifuentes-Grillo PA, Gutiérrez-Soriano L. Duodenal hemangiolymphangioma presenting as chronic anemia: a case report. BMC Res Notes 2016; 9:426. [PMID: 27581369 PMCID: PMC5007800 DOI: 10.1186/s13104-016-2214-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 08/11/2016] [Indexed: 02/08/2023] Open
Abstract
Background Lymphangiomas are a heterogeneous group of congenital vascular malformations characterized by cystic dilation of lymphatic vessels. They can occur at any age, but they are more common during childhood and in cutaneous localizations. Hemangiomas and vascular malformations of the gastrointestinal tract are very uncommon. Most are asymptomatic and diagnosis is often made as an incidental finding during endoscopy. On rare occasions the initial manifestation can be chronic anemia due to low grade gastrointestinal bleeding. They constitute an unusual manifestation and there is a low incidence of this type of tumor. Case presentation We report the case of a 43 year-old latin female, with a 2-year history of chronic anemia requiring blood transfusion. Hemoglobin and Hematocrit count were low, therefore further studies were required to rule out bleeding sources or other causes of anemia. Enteroscopy findings showed a 35 mm lesion taking up 50 % of the circumference in the distal duodenum, with raised whitish edges secondary to confluent lymphangiectasia, a center with a vascular appearance and active bleeding spots. Biopsy samples dyed with India ink confirmed the diagnosis of hemangiolymphangioma. Conclusion Diagnostic difficulties in this case, highlight the need to include hemangiolymphangioma in the differential diagnosis of chronic anemia as well as the need for multiple diagnostic methods to confirm the presence of the condition.
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Affiliation(s)
| | | | - Jorge Ceballos
- Fundación Cardioinfantil - Instituto de Cardiología, Bogotá, Colombia
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Chen H, Fu S, Feng N, Chen H, Gao Y, Zhao Y, Xue H, Zhang Y, Li X, Dai J, Fang J, Ge Z. Bleeding recurrence in patients with gastrointestinal vascular malformation after thalidomide. Medicine (Baltimore) 2016; 95:e4606. [PMID: 27537596 PMCID: PMC5370822 DOI: 10.1097/md.0000000000004606] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Thalidomide may be used for the treatment of gastrointestinal vascular malformation (GIVM), but the long-term response and adverse effects are unknown. Aim to study the recurrence rate of GIVM bleeding after thalidomide treatment, the response to treatment, and the adverse effects.This was a retrospective study of 80 patients with GIVM treated with thalidomide between November 2003 and November 2013. Patients received a course of 100 mg/day of thalidomide for 4 months and were followed up for at least 1 year. The response rate during follow-up, the recurrence rate after the 1st course of treatment, and the rate of retreatment were assessed. Comorbidities, the need for blood transfusion, yearly bleeding episodes, hemoglobin levels, hospitalization after thalidomide treatment, and the rate of adverse effects were also examined.The overall response rate during follow-up was 79.5% (62/78). The recurrence rate was 21.0% after the 1st course of thalidomide. The response rate of retreatment was 100%. After thalidomide treatment, yearly blood transfusion amounts, yearly bleeding episodes, and yearly hospitalization numbers were significantly decreased, while hemoglobin levels were significantly increased (P < 0.001). Adverse effects were observed in 60.0% (48/80) of the patients. Serious adverse effects were reported in 31.3% (25/80). The overall response rate was 76.7% (23/30) in 30 patients with comorbidities, while the rate was 78.0% (39/50) in patients without comorbidities (P = 0.55). The rate of serious adverse effects was similar between the comorbidities (33.3%) and no-comorbidities groups (30.0%) (P = 0.76).Thalidomide showed a good response rate and low adverse effect rate in patients with recurrent gastrointestinal bleeding due to GIVM.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Zhizheng Ge
- Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao-Tong University, Shanghai, China
- Correspondence: Zhizheng Ge, Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao-Tong University, 145 Middle Shandong Road, Shanghai 200001, China (e-mail: )
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Sphincter-saving resection of rectal hemangioma based on Doppler transrectal ultrasonography findings: report of a case. Int Surg 2016; 99:705-9. [PMID: 25437574 DOI: 10.9738/intsurg-d-13-00084.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
A 52-year-old woman was diagnosed with rectal hemangioma that had resulted in chronic bleeding. Klippel-Trenaunay syndrome was diagnosed by clinical examination. She was referred 30 years later because of progressive anemia. Colonoscopy revealed multiple bluish, polypoid nodules with severe vascular congestion and varicosis that had circumferentially spread along the wall from the dentate line to the rectosigmoid lesion. Selective abdominal angiography indicated that the hemangioma fed from the sigmoid artery and superior rectal artery. Doppler transrectal ultrasonography showed heterogeneous lesions with hypoechoic areas mostly in the submucosal layer, partly forming the mosaic pattern of the color flow signal in the intersphincteric layer on the oral side from the dentate line to 1 cm. Anterior resection and coloanal anastomosis with covering ileostomy was performed. Using a transanal approach, mucosectomy and intersphincteric resection were performed based on the Doppler transrectal ultrasonography results. There were no intraoperative complications, and her anemia resolved postoperatively.
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Lee YJ, Hwang JY, Cho YH, Kim YW, Kim TU, Shin DH. A long-Segmental Vascular Malformation in the Small Bowel Presenting With Gastrointestinal Bleeding in a Preschool-Aged Child. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e29260. [PMID: 27110342 PMCID: PMC4835636 DOI: 10.5812/iranjradiol.29260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 05/30/2015] [Accepted: 06/05/2015] [Indexed: 11/16/2022]
Abstract
Gastrointestinal (GI) bleeding in pediatric patients has several causes. Vascular malformation of the small bowel is a rare disease leading to pediatric GI bleeding. To our knowledge, few reports describe ultrasound and computed tomography findings of venous malformations involving the small bowel. We present a case of long-segmental and circumferential vascular malformation that led to GI bleeding in a pre-school aged child, focusing on the radiologic findings. Although vascular malformation including of the GI tract is rare in children, it should be considered when GI bleeding occurs in pediatric patients.
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Affiliation(s)
- Yeoun Joo Lee
- Department of Pediatrics, Pusan National University Children’s Hospital, Pusan National University, School of Medicine, Yangsan, Republic of Korea
| | - Jae-Yeon Hwang
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University, School of Medicine, Yangsan, Republic of Korea
- Corresponding author: Jae-Yeon Hwang, Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University, School of Medicine, Yangsan, Republic of Korea. Tel: +82-553602778, Fax: +82-553601848, E-mail:
| | - Yong Hoon Cho
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University, School of Medicine, Yangsan, Republic of Korea
| | - Yong-Woo Kim
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University, School of Medicine, Yangsan, Republic of Korea
| | - Tae Un Kim
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University, School of Medicine, Yangsan, Republic of Korea
| | - Dong Hoon Shin
- Department of Pathology, Pusan National University Yangsan Hospital, Pusan National University, School of Medicine, Yangsan, Republic of Korea
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Choi HY, Lee KM, Kim EJ, Choi WS. Diffuse infiltrative laryngoesophageal and peritoneal venous malformations mimicking carcinomatosis with a subclavian vein aneurysm. Clin Imaging 2015; 39:1099-102. [PMID: 26324217 DOI: 10.1016/j.clinimag.2015.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 07/16/2015] [Accepted: 07/30/2015] [Indexed: 12/01/2022]
Abstract
Venous malformations are benign vascular lesions that can occur in any part of the body. Esophageal venous malformations can extend into the peritoneum, so preoperative imaging can be decisive in diagnosis and treatment. The characteristic manifestations of venous malformations are transmural phleboliths, centripetal enhancement on dynamic CT, and bluish mucosa on endoscopy. We report a rare case of female patient diagnosed with venous malformations involving laryngoesophagus, mediastinum, and peritoneum, which mimicked carcinomatosis, in addition to a left subclavian vein aneurysm.
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Affiliation(s)
- Hee Young Choi
- Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, #26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
| | - Kyung Mi Lee
- Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, #26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-701, Republic of Korea.
| | - Eui Jong Kim
- Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, #26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
| | - Woo Suk Choi
- Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, #26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
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46
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Andrade P, Lopes S, Macedo G. Diffuse cavernous hemangioma of the rectum: case report and literature review. Int J Colorectal Dis 2015; 30:1289-90. [PMID: 26243468 DOI: 10.1007/s00384-015-2329-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Patrícia Andrade
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar de São João, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal,
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Smirnov AV, Gorin DS, Kalinin DV, Berelavichus SV, Kriger AG. [Laparoscopic ileocecal resection for cecalangiodysplasia]. Khirurgiia (Mosk) 2015:72-73. [PMID: 26271428 DOI: 10.17116/hirurgia2015672-73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A V Smirnov
- A.V. Vishnevskiy Institute of Surgery, Health Ministry of the Russian Federation, Moscow, Russia
| | - D S Gorin
- A.V. Vishnevskiy Institute of Surgery, Health Ministry of the Russian Federation, Moscow, Russia
| | - D V Kalinin
- A.V. Vishnevskiy Institute of Surgery, Health Ministry of the Russian Federation, Moscow, Russia
| | - S V Berelavichus
- A.V. Vishnevskiy Institute of Surgery, Health Ministry of the Russian Federation, Moscow, Russia
| | - A G Kriger
- A.V. Vishnevskiy Institute of Surgery, Health Ministry of the Russian Federation, Moscow, Russia
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Janko N, Nguyen TC, Lubel J. Looking beyond the scope: recurrent rectal bleeding in a young woman. Gut 2015; 64:1119, 1157. [PMID: 25550181 DOI: 10.1136/gutjnl-2014-308740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/06/2014] [Indexed: 12/08/2022]
Affiliation(s)
- Natasha Janko
- Department of Gastroenterology and Hepatology, Eastern Health, Melbourne, Victoria, Australia
| | - T C Nguyen
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - John Lubel
- Department of Gastroenterology and Hepatology, Eastern Health, Melbourne, Victoria, Australia Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
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49
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Yoo S. Hemangiomas and vascular malformations of the GI tract. SEMINARS IN COLON AND RECTAL SURGERY 2015. [DOI: 10.1053/j.scrs.2015.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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