• Gastrointestinal surgery
• Interventional radiology

• Female
• Humans
• Diagnosis, Differential
• Quality of Life
• Rectum/diagnostic imaging
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Vascular Malformations/diagnosis
• Vascular Malformations/diagnostic imaging
• Cardiovascular Abnormalities

• arteriovenous malformation
• rectal vascular malformation
• total mesorectal excision

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.

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.

The current report will increase the understanding of the diagnosis and treatment of gastrointestinal hemangiomas and provide a review of the related literature.

• Gastrointestinal hemangioma
• Racemose hemangioma
• Small bowel obstruction
• Chronic anemia
• Computed tomography
• Case report

• Anemia/etiology
• Child, Preschool
• Chronic Disease
• Diagnosis, Differential
• Female
• Hemangioma/complications
• Hemangioma/diagnosis
• Hemangioma/pathology
• Hemangioma/surgery
• Humans
• Ileal Neoplasms/complications
• Ileal Neoplasms/diagnosis
• Ileal Neoplasms/pathology
• Ileal Neoplasms/surgery
• Ileum/diagnostic imaging
• Ileum/pathology
• Ileum/surgery
• Intestinal Obstruction/etiology
• Intestinal Obstruction/surgery
• Laparoscopy
• Melena/etiology
• Melena/surgery
• Teratoma/diagnosis
• Tomography, X-Ray Computed
• Treatment Outcome

Isolated gastrointestinal venous malformations (GIVMs) are extremely rare congenital developmental abnormalities of the venous vasculature. Because of their asymptomatic nature, the diagnosis is often quite challenging. However, as symptomatic GIVMs have nonspecific clinical manifestations, misdiagnosis is very common. Here, we report a case of isolated diffuse GIVMs inducing mechanical intestinal obstruction. A literature review was also conducted to summarize clinical features, diagnostic points, treatment selections and differential diagnosis in order that doctors may have a comprehensive understanding of this disease.

A 50-year-old man presented with recurrent painless gastrointestinal bleeding for two months and failure to pass flatus and defecate with nausea and vomiting for ten days. Digital rectal examination found bright red blood and soft nodular masses 3 cm above the anal verge. Computed tomography showed that part of the descending colon and rectosigmoid colon was thickened with phleboliths in the intestinal wall. Colonoscopy exhibited bluish and reddish multinodular submucosal masses and flat submucosal serpentine vessels. Endoscopic ultrasonography showed anechoic cystic spaces within intestinal wall. The lesions were initially thought to be isolated VMs involving part of the descending colon and rectosigmoid colon. Laparoscopic subtotal proctocolectomy, pull-through transection and coloanal anastomosis and ileostomy were performed. Histopathology revealed intact mucosa and dilated, thin-walled blood vessels in the submucosa, muscularis, and serosa involving the entire colorectum. The patient recovered with complete symptomatic relief during the 52-mo follow-up period.

The diagnosis of isolated GIVMs is challenging. The information presented here is significant for the diagnosis and management of symptoms.

• Case report
• Isolated gastrointestinal venous malformations
• Mechanical intestinal obstruction
• Pull-through transection and coloanal anastomosis
• Diagnosis
• Treatment

• Colorectal
• Haemangioma
• Surgery

• Administration, Oral
• Antifibrinolytic Agents/administration & dosage
• Colonoscopy
• Conservative Treatment/methods
• Gastrointestinal Hemorrhage/etiology
• Hemangioma, Cavernous/diagnosis
• Hemangioma, Cavernous/drug therapy
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Multimodal Imaging
• Rectal Neoplasms/diagnosis
• Rectal Neoplasms/drug therapy
• Sigmoid Neoplasms/diagnosis
• Sigmoid Neoplasms/drug therapy
• Tomography, X-Ray Computed
• Tranexamic Acid/administration & dosage
• Treatment Outcome
• Watchful Waiting

This case seeks to highlight to endoscopists a rare benign disorder that may be encountered during endoscopy. Clinicians may be tempted to biopsy, which could lead to a catastrophic gastrointestinal haemorrhage.

A 66-year-old asymptomatic Caucasian male was referred for colonoscopy with a positive faecal occult blood test as part of the UK national bowel cancer screening programme. Relevant past medical history included atrial fibrillation for which he took Dabigatran. He had a normal haemoglobin, mean cell volume, platelet and clotting function.

During colonoscopy, an unusual vascular pattern encompassing the entire rectum extending to the rectosigmoid junction was noted at intubation. The lesion demonstrated confluent circumferential purple discolouration indicating venous blood supply, with heaping up of the mucosa involving the entire rectum and rectosigmoid junction. There was no corresponding history of venothromboembolic disease or liver disease. The patient proceeded to have computed tomography (CT) which revealed a considerably thickened rectosigmoid wall with multiple small rounded punctate calcifications within it, and no other visceral involvement. Subsequent magnetic resonance (MR) scan of the pelvis demonstrated extensive diffuse thickening of the rectum and lower sigmoid with intermediate to high T2 signal, and an internal architecture of multiple ‘grapelike’ lobulations.

The findings were consistent with diffuse cavernous haemangiomatosis of the rectum (DCHR), an extremely rare benign submucosal vascular intestinal tumour originating from the dentate line. Misdiagnosis of DCHR is common and the macroscopic appearance of DCHR can mimic varices, haemorrhoids, polyps or proctitis. MR imaging is the gold standard for diagnosis. Common presentation is with haematochezia due to mucosal wall erosion. The treatment of choice for symptomatic DCHR is pull-through transection and colo-anal anastomosis. This case seeks to highlight a rare disorder that can be encountered incidentally during lower GI endoscopy. Injudicious biopsy is potentially catastrophic. In a patient who endoscopically has evidence of a DCHR, we advocate MR pelvis assessment to clarify the nature of the lesion to guide future management if required. The patient discussed remains well, asymptomatic, with no evidence of iron deficiency anaemia.

• Case report
• Diffuse cavernous haemangiomatosis of the rectum
• Endoscopy
• Magnetic resonance imaging