Laparoscopic-assisted bowel resection with construction of a colonic reservoir for cavernous hemangioma of the rectum: report of two cases

Diffuse cavernous hemangioma of the rectum is an unusual benign vascular lesion, marked by delayed diagnosis and often presenting recurrent rectal bleeding and anemia. Colorectal resection with coloanal anastomosis and construction of a colonic reservoir is the preferred surgical treatment. We report two cases of patients, a 23-year-old man and a 27-year-old woman, with cavernous hemangioma of the rectum, diagnosed by colonoscopy and confirmed by magnetic resonance imaging. Arteriography demonstrated vascular tumors in the rectal wall. Use of the embolization technique was not successful, since no large caliber vessel was available for this procedure. The patients underwent anterior abdominal excision of the rectum with a laparoscopic approach+ colonic reservoir and hand sewn coloanal anastomosis. Ileostomy closure was performed in both patients at 3 months after surgery, and they demonstrated good early and late postoperative outcomes. In summary, laparoscopic-assisted bowel resection may be a good option for surgical management of diffuse cavernous hemangioma of the rectum.     

Diffuse cavernous hemangioma of the rectosigmoid colon

Diffuse cavernous hemangioma of the rectosigmoid colon is an uncommon benign vascular lesion. We report 5 cases of diffuse cavernous hemangioma, focusing on the clinical features, diagnosis procedure and treatment. Five patients have undergone sphincter–saving procedures, 3 cases had coloanal sleeve anastomoses and 1 patient each had pull–through anastomosis and lower anterior resection. During the follow–up, which ranged from 3 to 10 years, 3 patients had no further anal bleeding and 2 patients had minor intermittent anal bleeding. Continence for normal stool was satisfactory in all patients. In conclusion, sphincter–saving procedure is most appropriate and curative approach for the treatment of diffuse cavernous hemangioma. Imaging study plays an important role in the diagnosis, preoperative staging and follow–up.     

Sphincter-saving procedure for treatment of diffuse cavernous hemangioma of the rectum and sigmoid colon

Two cases of diffuse cavernous hemangioma of the rectum and rectosigmoid colon are reported. Sphincter-saving procedures were applied as the surgical treatment for these two patients. The diseased rectum and distal sigmoid colon were resected 3 cm above the pectinate line. The mucosa of the rectal stump was extirpated. All visible residue from the hemangiomatous tissues on the muscular cuff, pararectal space, and pelvic wall were denuded. The normal colon was then pulled down through the rectal cuff and anastomosed with anoderm, and attached to the internal sphincter muscle. Both patients recovered uneventfully. No uncontrollable hemorrhage was encountered during rectal dissection. Both patients had good anal sensation and perfect continence. No complicated sexual or urinary disturbances were found. The sphincter-saving procedure for treatment of diffuse cavernous hemangioma of the rectum should be promoted and given first choice whenever possible. Read at the Tenth Biennial Congress of the International Society of University Colon and Rectal Surgeons, Strasburg, France, September 1984.     

Hemangioma of the rectum: CT appearance

An 18-year-old man who had severe recurrent rectal bleeding and hematuria was found to have a diffuse cavernous hemangioma of the rectosigmoid. A computed tomographic (CT) study was indicated to evaluate tumor extension and therapeutic possibilities. CT scanning revealed a large mass with phleboliths throughout the true pelvis and nodular indentations in the rectosigmoid wall involving the dome and posterior wall of the bladder. A nonhomogeneous and subtle enhancement of the lesion was noticed after injection of contrast medium.     

Diffuse cavernous hemangioma of the rectum complicated by invasion of pelvic structures

PURPOSE: We present two cases of diffuse cavernous hemangioma of the rectum that invaded the pelvic structures. METHODS: Two young women suffering from intermittent rectal bleeding were studied using computed tomography and magnetic resonance imaging. RESULTS: Beside the rectal hemangioma, computed tomography and magnetic resonance imaging revealed that the pelvic ureter and the iliac vessels were each eroded by the tumor that produced symptoms in these two patients. CONCLUSION: Computed tomography and magnetic resonance imaging permit direct visualization for tumor staging and also for recognition of any pelvic structure invasion, which facilitate preoperative assessment of diffuse cavernous hemangioma of the rectum.     

Cavernous,arteriovenous, and mixed hemangioma–lymphangioma of the rectosigmoid: rare causes of rectal bleeding—case series and review of the literature

Introduction Cavernous hemangiomas of the sigmoid colon and rectum are uncommon vascular malformations usually found in young adults with a long history of episodic and painless rectal bleeding. Alternatively, they may present with massive life-threatening hemorrhage. Discussion We report three cases of hemangioma of the rectosigmoid including one case of cavernous hemangioma, one case of arteriovenous hemangioma, and one case of hemangiolymphangiomatosis with emphasis on clinical presentation, radiologic, operative, and pathologic findings. Definitive treatment consists of complete resection with a sphincter-preserving procedure or abdominoperineal resection, based on extent of disease. Conclusion Therapy is typically delayed by several years in these patients due to erroneous diagnosis and failed treatment of hemorrhoids and inflammatory bowel disease. Relative to hemangiomas, lymphangiomas of the rectosigmoid are even more rare and when symptomatic, present with rectal bleeding and pelvic pain.     

Diffuse cavernous hemangioma of the rectum: Report of a case and review of the literature

Summary Various aspects of diffuse cavernous hemangioma of the rectum are discussed. The clinical features of chronic rectal bleeding, often beginning in infancy, the proctoscopic findings of fleshy mucosal rectal folds, and the radiologic findings of multiple rectal phleboliths, all serve to establish the diagnosis of this rare disease. Abdominoperineal excision of the rectum is considered by the authors to be the preferred treatment. Cure was achieved in the case reported.     

Diagnostics and surgical treatment strategy for rectal cavernous hemangiomas based on three case examples

A 20-year-old man with a congenital vascular malformation extending from the anal canal into the distal sigmoid had had recurrent perianal blood loss as a neonate. A hemangioma was diagnosed for the first time in 1978. The patient received regular and frequent gastroenterological treatment until admission. Decisive for the indication for surgery was the patient’s need for blood infusions and shorter bleeding intervals in June 1998. Surgical therapy consisted of deep anterior rectosigmoid resection with coloanal pouch anastomosis. In a second case of a 27-year-old woman a sigmoid hemangioma was diagnosed in conjunction with emergency sigmoid resectioning. Because of recurrent hemorrhages a coloanal pouch was also established here in a second step. The third case involved a 19-year-old woman with a 12-year history of repeated perianal hemorrhages. After sigmoid discontinuity resection we carried out proctectomy with descendostoma creation due to renewed severe intractable perianal bleeding. The histological examination revealed a rectal hemangioma that had caused the repeated perianal hemorrhages. Surgical reconstruction was then achieved by coloanal pouch anastomosis. In view of the good functional and perioperative results, current surgical therapy should aim at preserving continuity and continence by coloanal pouch anastomosis. Accepted: 12 November 1999     

Mechanical bowel obstruction due to colonic hemangioma: report of a case.

Colon hemangiomas are rare benign vascular lesions which are usually seen in teenagers. The frequent presentation is repetitive painless rectal bleeding. Colonic hemangiomas are occasionally found in the rectosigmoid area. A 62-year-old male patient was admitted to the hospital with the complaints of mechanical bowel obstruction. The radiological imaging techniques revealed a transverse colon tumor. Consequently, the patient was operated, and transverse colectomy and end-to-end anastomosis were performed. No postoperative complications occurred. The pathologic examination revealed cavernous hemangioma of the transverse colon. This report describes a very rare case of bowel obstruction due to colonic hemangioma.     

Bleeding from cavernous angiomatosis of the rectum in Klippel-Trenaunay syndrome: report of three cases and literature review

Klippel-Trenaunay syndrome (KTS) is a congenital vascular anomaly characterized by limb hypertrophy, cutaneous hemangiomas, and varicosities. GI hemorrhage is a potentially serious complication secondary to diffuse hemangiomatous involvement of the gut. We report on three patients with KTS who presented with transfusion-dependent anemia and life-threatening bleeding due to extensive cavernous hemangiomas involving the rectum. Two patients were treated by proctocolectomy and coloanal anastomosis, which preserved anal function while controlling bleeding. The third patient required an abdominoperineal resection because of extensive rectal, perianal, and perineal angiomatosis. The literature on the evaluation and management of GI hemorrhage in KTS, particularly of colorectal origin, is reviewed.     

Cavernous hemangioma of the rectum--a rare differential per anal hemorrhage diagnosis

A 19-year-old woman suffered from recurrent peranal hemorrhage. Over a period of five years she was treated under the suspicion of ulcerative colitis. After a sigmoid resection with a colostomy, proctectomy with an end colostomy followed due to recurrent intractable peranal hemorrhage. Histology of the specimen showed surprisingly a hemangioma of the rectum. Thereafter reconstruction was performed by colopouchanal anastomosis. Afterwards the patient was free of disease and had a good stool-continence. Stool-frequency was twice daily. The second case consisted in a 27-year-old woman who underwent emergency sigmoidectomy due to massive peranal hemorrhage. Here as well diagnosis was a hemangioma of the sigmoid. One year after the first operation the patient had a recurrence of peranal bleeding again due to rectal hemangioma. Since endoscopy and endosonography confirmed a rectal hemangioma a rectal exstirpation with a colopouchanal reconstruction was performed successfully. The reviewed literature shows including the two presented cases a total of 81 cases with rectal hemangiomas. Because of the good results concerning function and morbidity the therapy of choice is rectal exstirpation with colopouchanal reconstruction.     

Diffuse cavernous hemangioma of the rectum: evaluation and MRI

Computed tomography (CT) and magnetic resonance imaging (MRI) were used preoperatively to stage the extent of a diffuse rectal hemangioma in a 37-year-old man with recurrent rectal bleeding. On T2-weighted MR scans, the lesion demonstrated a heterogenous signal intensity with large portions displaying the hyperintensity characteristic of hemangiomas of solid organs. MRI did not depict calcified phleboliths evident on CT and barium enema.     

The blue rubber bleb nevus or the cellular blue nevus or Bean syndrome. A rare case of iron-deficiency anemia]

Described by Bean in 1958 the Blue rubber bleb nevus syndrome is a viscero-cutaneous hemangiomatosis, a rare condition associating typical cutaneous and visceral hemangiomas of the cavernous type. We report the case of a four year old boy who presented a microcytic and hyperchromic anemia. The previous medical history of this boy was characterized by a large cavernous angioma on the right hand operated on the at the age of three months. The stools were guaiac-positive; examination of the gastrointestinal tract to clarify the etiology of gastrointestinal bleeding was negative. An oral iron therapy was prescribed for several years by the pediatrician. At age nine and half years Labeled erythrocytes demonstrated that gastrointestinal bleeding still continues. The indication for surgical operation was established: Small bowel enteroclysis revealed an oval filling defect in the lumen of ileum. Intraoperative finding: Protuberous hemangioma in the wall of small bowel; resection of the involved intestine and primary anastomosis were performed. On histological examination a cavernous hemangioma has been observed. Clinic and Pathology of this rare condition are discussed.     

Acute hemorrhage from right-colonic hemangiomas: Report of a case

Summary and Conclusion A rare case of severe rectal bleeding beginning in adult life is reported. A diffuse, cavernous hemangioma of the right transverse colon was visualized by superior mesenteric arteriography and the diagnosis was confirmed by peroperative colonoscopy carried out through a colotomy. The patient was treated by right hemicolectomy. the diagnostic value of selective abdominal arteriography in patients who have severe rectal bleeding is demonstrated.     

Diffuse cavernous hemangioma of the rectosigmoid—CT scan,a new diagnostic modality,and surgical management using sphincter-saving procedures

Diffuse cavernous hemangioma of the rectosigmoid is a rare lesion. Preoperative recognition has been recorded but, because of lack of awareness and inconsistent diagnoses inappropriate therapy still persists. Surgical therapy is the hallmark of treatment. Abdominoperineal resection has been advocated. Three cases of diffuse cavernous hemangiomas of the rectosigmoid, recognized preoperatively and treated successfully with sphincter-saving procedures, are reported. Use of the CT scan as a consistent diagnostic tool will be presented for the first time.     

Zonal adult Hirschsprung's disease.

BACKGROUND: Hirschsprung's disease is a congenital disorder which is rare in adulthood. In typical cases the aganglionosis involves mainly the rectum or rectosigmoid colon and the lesion starts from the anal valve. Zonal segmental aganglionosis is a very rare type even in children. PATIENT: A 54 year old women with zonal segmental aganglionosis had an aganglionic segment 18 cm in length located in the rectosigmoid colon with an 8 cm long normal appearing rectum and dilated proximal colon. Resection of the stenotic segment with end to end anastomosis was performed. CONCLUSION: The functional result was excellent five years after the operation.     

Diffuse cavernous hemangioma of the rectosigmoid colon with extraintestinal involvement.

Cavernous hemangioma of the colon is a rare cause of gastrointestinal bleeding. These lesions can be encountered as solitary, multiple, or part of a more complex syndrome with cutaneous manifestations. We herein describe a 26-year-old woman with cavernous hemangioma involving the rectosigmoid area. Additional hemangiomas were identified in the pelvic structures, spine, iliac bone and spleen. This multi-visceral involvement without cutaneous manifestations represents an intermediate variety between solitary hemangioma and well-defined syndromes with cutaneous and structural anomalies. The potential presence of extraintestinal hemangiomatosis should be considered and investigated in patients with cavernous hemangioma of the colon even without cutaneous manifestations or with a limited colonic involvement.     

Role of EUS and EUS-guided FNA in the diagnosis of symptomatic rectosigmoid endometriosis

BACKGROUND: Rectosigmoid endometriosis is an underrecognized cause of GI symptoms in women. Pelvic magnetic resonance imaging and CT have a low sensitivity in making this diagnosis. The role of EUS and EUS-guided FNA (EUS-FNA) in the diagnosis of rectosigmoid endometriosis in symptomatic patients is not well studied. METHODS: A review of medical records identified 5 women who were diagnosed with rectosigmoid endometriosis by EUS and EUS-FNA over a period of 1 year. OBSERVATIONS: Five women with nonspecific GI complaints underwent EUS examination of a rectosigmoid subepithelial mass found on colonoscopy. EUS revealed a hypoechoic lesion infiltrating the muscularis propria and the serosa of the rectal wall, and extending outside the rectal wall, findings consistent with rectosigmoid endometriosis. This diagnosis was confirmed by EUS-FNA, surgical exploration, and/or the patient's clinical course. CONCLUSIONS: EUS and EUS-FNA are noninvasive, sensitive techniques for the diagnosis of rectosigmoid endometriosis in symptomatic patients.     

<Emphasis Type="Italic">Per Anum</Emphasis> intersphincteric rectal dissection with direct coloanal anastomosis for lower rectal cancer

PURPOSE: The most important goal of sphincter-preserving operations for rectal cancer is to secure a distal surgical margin of safety and the anal sphincter. However, it is not always easy to transect the rectum and to secure a distal surgical margin of safety through the abdominal approach for tumors situated extremely low in the rectum. The aim of this study was to describe and to evaluate a new technique ofper anumintersphincteric rectal dissection and coloanal anastomosis. METHODS: The rectum, including the entire width of the internal anal sphincter, is transected circum ferentiallyviathe anal route to secure the surgical margin of safety under direct vision and is mobilized proximally as far as possible through the intersphincteric plane.Per anumcoloanal anastomosis is performed following transabdominal resection of the rectum. RESULTS: This technique has been used in 12 patients. There have been no instances of short-term or long-term anastomotic complications. CONCLUSIONS: This technique is safe when anastomosis must be performed at the dentate line. It is the best sphincter-preserving operation for lower rectal cancer and does not result in serious postoperative anal dysfunction.     

Rectal Dieulafoy's lesion

Dieulafoy's lesion is an uncommon cause of gastrointestinal bleeding that occurs after rupture of an exposed submucosal artery. The vast majority of lesions are found in the stomach, but cases have been described in the esophagus, small intestine, colon, and rectum. We describe an elderly patient who presented with severe lower gastrointestinal bleeding caused by a rectal Dieulafoy's lesion. This is the first report of a rectal Dieulafoy's lesion treated successfully with endoscopic epinephrine injection followed by thermocoagulation. We review the physiopathology, clinical presentation, diagnosis, and treatment of this disease.