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

Abstract

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.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    Ajiki T, Nakamura T, Kubota S, Kim YS, Kuroda Y (2000) Successful endoscopic treatment of colon lymphangioma with a ligating device. Gastrointest Endosc 52:800–802

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Amarapurkar D, Jadliwala M, Punamiya S, Jhawer P, Chitale A, Amarapurkar A (1998) Cavernous hemangioma of the rectum: report of three cases. Am J Gastroenterol 93:1357–1359

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Aylward CA, Orangio GR, Lucas GW, Fazio VW (1988) Diffuse cavernous hemangioma of the rectosigmoid. CT scan, a new diagnostic modality, and surgical management using sphincter-saving procedures. Dis Colon Rectum 31:797–802

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Corman ML (2005) Colon and rectal surgery, 5th ed. Lippincott Williams and Wilkins, Philadelphia

    Google Scholar 

  5. 5.

    Corman ML, Haggitt RC (1973) Lymphangioma of the rectum. Dis Colon Rectum 16:524–529

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Cunningham JA, Garcia VF, Quispe G (1989) Diffuse cavernous rectal hemangioma-sphincter-sparing approach to therapy. Report of a case. Dis Colon Rectum 32:344–347

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Dachman AH, Ros PR, Shekitka KM, Buck JL, Olmsted WW, Hinton CB (1988) Colorectal hemangioma: radiologic findings. Radiology 167:31–34

    PubMed  CAS  Google Scholar 

  8. 8.

    Dalton ML, Gronvall JA (1963) Lymphangioma of the rectum: report of a case. Dis Colon Rectum 6:385–386

    PubMed  Article  Google Scholar 

  9. 9.

    Enzinger FM, Weiss SW (eds) (1995) Soft tissue tumors, 3rd edn. Mosby, New York

  10. 10.

    Hizawa K, Aoyagi K, Kurahara K, Suekane H, Kuwano Y, Nakamura S, Fujishima M (1996) Gastrointestinal lymphangioma: endosonographic demonstration and endoscopic removal. Gastrointestinal Endosc 43:620–624

    CAS  Google Scholar 

  11. 11.

    Irisawa A, Bhutani MS (2001) Cystic lymphangioma of the colon: endosonographic diagnosis with through-the-scope catheter miniprobe and determination of further management. Report of a case. Dis Colon Rectum 44:1040–1042

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Kim KM, Choi KY, Lee A, Kim BK (2000) Lymphangioma of large intestine: report of ten cases with endoscopic and pathologic correlation. Gastrointest Endosc 52:255–259

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Kuramoto S, Sakai S, Tsuda K, Kaminishi M, Ihara O, Oohara T, Jinbo S, Murakami T (1988) Lymphangioma of the large intestine. Report of a case. Dis Colon Rectum 31:900–905

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Levy AD, Abbott RM, Rohrmann CA, Frazier AA, Kende A (2001) Gastrointestinal hemangiomas: imaging findings with pathologic correlation in pediatric and adult patients. AJR Am J Roentgenol 177:1073–1081

    PubMed  CAS  Google Scholar 

  15. 15.

    Oner Z, Altaca G (1993) Diffuse cavernous rectal hemangioma–clinical appearance, diagnostic modalities and sphincter saving approach to therapy: report of 2 and a collective review of 79 cases. Acta Chir Belg 93:173–176

    PubMed  CAS  Google Scholar 

  16. 16.

    Park SJ, Lee JW, Han JK (1999) Images of interest. Gastrointestinal: gastrointestinal lymphangiomas. J Gastroenterol Hepatol 14:101

    PubMed  Article  Google Scholar 

  17. 17.

    Tai PT, Jewell LD (1995) Case report: mesenteric mixed haemangioma and lymphangioma; report of a case with 10 year follow-up after radiation treatment. Br J Radiol 68:657–661

    PubMed  CAS  Article  Google Scholar 

  18. 18.

    Varma JD, Hill MC, Harvey LAC (1998) Hemangioma of the small intestine manifesting as gastrointestinal bleeding. Radiographics 741:1029–1033

    Google Scholar 

  19. 19.

    Wang HT, Tu Y, Fu CG, Meng RG, Cui L, Xu HL, Yu DH (2005) Diffuse cavernous hemangioma of the rectosigmoid colon. Tech Coloproctol 9:145–148

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Yorozuya K, Watanabe M, Hasegawa H, Baba H, Imai Y, Mukai M, Kitajima M (2003) Diffuse cavernous hemangioma of the rectum: report of a case. Surg Today 33:309–311

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Randolph M. Steinhagen.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Sylla, P., Deutsch, G., Luo, J. et al. Cavernous, arteriovenous, and mixed hemangioma–lymphangioma of the rectosigmoid: rare causes of rectal bleeding—case series and review of the literature. Int J Colorectal Dis 23, 653–658 (2008). https://doi.org/10.1007/s00384-008-0466-4

Download citation

Keywords

  • Cavernous hemangioma
  • Arteriovenous hemangioma
  • Hemangiolymphangiomatosis
  • Rectal bleeding