直肠海绵状血管瘤漏诊破裂大出血1例报告

直肠血管瘤(CHR)比较罕见,好发于肛门齿线2cm以上直肠黏膜下,病理特点为直肠黏膜下及肌层内见大量扩张的血管及血窦,腔内充满红细胞;常以便血为主诉,易与内痔、溃疡性结肠炎、结肠癌、肠憩室出血等出血性肛肠疾病相混淆,常规辅助检查难以检出,肛门指诊难以触及,尤其合并其它直肠部出血性疾病更罕见,易漏诊、误诊;便血特点为长期、少量、反复、无痛,病程长,患者多有贫血貌,肿瘤较大者可有肠道刺激症,表现为腹部隐痛,大便次数多甚者频繁便意,黏液便,里急后重等。肠壁黏膜有严重炎症、溃疡、出血时会掩盖血管瘤,肠镜不易检出。异常血流导致平滑肌减少,活检容易引起严重出血,纤维结肠镜需谨慎施行。鉴于肠镜可视范围的局限,以及直肠黏膜出血、糜烂的掩盖性、活检时易致出血的风险性,无创性检查在直肠血管瘤的检查中发挥着重要的作用。应尽量将彩色超声多普勒、CT/MRI等检查纳入此类便血的常规检查。

The Case of Rupture Bleeding due to Diagnosis Miss of Cavernous Hemangioma of the Rectum

Cavernous hemangioma of the rectum(CHR) is relatively rare.It often occurs under the intestinal submucosa,a place 2 cm above the anal dentate line.CHR pathologically features abundant hemangiectasis and hematococoel under the intestinal-submucosa/muscular-layer,and full of red blood cells within those cavities.CHR has a cardinal symptom of hematochezia and is easily confused with bleeding internal hemorrhoids,ulcerative colitis,colon cancer,diverticulosis bleeding anorectal disease.It can hardly be diagnosed with common auxiliary examination and is out of reach by digital rectal examination.CHR can be missed in diagnosis or misdiagnosed especially when combined with other rectal bleeding disorders.Its,hematochezia is often chronic,modest,repeating and painless.Most patients have anemia looks.Symptoms of intestinal irritation can be observed if tumors are relatively large,with clinical manifestation of hypogastrium pain,frequent defecation or constant desire to defecate,mu-cous stool and tenesmus etc.Hemangioma can be masked when intestinal mucosa has serious inflammation,ulcer or bleeding,in which case it is not easy to detect by colonoscopy.Since abnormal blood flow can reduce smooth muscles and biopsy can cause serious bleeding,fiber colonoscopy should be carefully conducted.Given the limited visibility of colonoscopy as well as the risk of rectal mucosa bleeding,erosion concealment and bleeding during biopsy,noninvasive examination plays an important role in rectal hemangioma examination.We should try to bring color ultrasonic doppler,CT/MRI examination into routine examinations of such type of hematochezia.