Abstract
Background
Diffuse cavernous hemangioma of the rectum (DCHR) is a rare benign vascular disease, which is often misdiagnosed and difficult to treat.
Methods
Seventeen cases of DCHR in our hospitals from 1995 to 2009 were identified. The detailed data of diagnosis, treatment, and prognosis were carefully studied.
Results
Seven, three, two, and one patient were mistaken as having hemorrhoids, colitis, portal hypertension, and rectal polypus, respectively. The mean delay time between initial symptoms and final diagnosis was 17.63 years (range = 0–48 years). Colonoscopy and MRI were important in the diagnosis of DCHR because of their high positive rates and specific features. All of the lesions originated from the dentate line, extending to the proximal colorectal wall. Most of the lesions were found to be restricted to the rectosigmoid wall and the rectal mesentery. Involvement of right gluteus maximus and right leg was revealed by MRI in two patients. After admission, six patients underwent coloanal sleeve anastomosis and seven patients underwent pull-through transection and coloanal anastomosis. The latter procedure was superior to the former with respect to length of operation, intraoperative blood loss, intraoperative blood transfusion, and perioperative complications.
Conclusion
DCHR is often misdiagnosed. Preoperative colonoscopy and MRI are essential in making the correct diagnosis and to depict the extent of the lesion accurately. Due to its origination from the dentate line and the involvement of the whole layer of the rectal wall and the rectal mesentery, the treatment of choice for DCHR is complete resection by the pull-through transection and coloanal anastomosis.
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References
Mathai V, Vyas FL, Jesudason SR (2003) Cavernous haemangioma of the rectum: an uncommon cause of rectal bleeding. Trop Gastroenterol 24:42–43
Wang HT, Tu Y, Fu CG et al (2005) Diffuse cavernous hemangioma of the rectosigmoid colon. Tech Coloproctol 9:145–148
Amarapurkar D, Jadliwala M, Punamiya S et al (1998) Cavernous hemangiomas of the rectum: report of three cases. Am J Gastroenterol 93:1357–1359
Phillips B (1839) Surgical cases. Lond Med Gaz 23:514–517
Kimura S, Tanaka S, Kusunoki H et al (2007) Cavernous hemangioma in the ascending colon treated by endoscopic mucosal resection. J Gastroenterol Hepatol 22:280–281
Hervias D, Turrion JP, Herrera M et al (2004) Diffuse cavernous hemangioma of the rectum: an atypical cause of rectal bleeding. Rev Esp Enferm Dig 96:346–352
Yorozuya K, Watanabe M, Hasegawa H et al (2003) Diffuse cavernous hemangioma of the rectum: report of a case. Surg Today 33:309–311
Tanaka N, Onda M, Seya T et al (1999) Diffuse cavernous haemangioma of the rectum. Eur J Surg 165:280–283
Chen CH, Jones J, McGowan P (2009) Profound iron deficiency anemia caused by a small-intestinal cavernous hemangioma. Gastrointest Endosc 69:1392–1393
Willert RP, Chong AK (2008) Multiple cavernous hemangiomas with iron deficiency anemia successfully treated with double-balloon enteroscopy. Gastrointest Endosc 67:765–767
Marinis A, Kairi E, Theodosopoulos T et al (2006) Right colon and liver hemangiomatosis: a case report and a review of the literature. World J Gastroenterol 12:6405–6407
Topalak O, Gonen C, Obuz F et al (2006) Diffuse cavernous hemangioma of the rectosigmoid colon with extraintestinal involvement. Turk J Gastroenterol 17:308–312
Kaiser AM, Spanos C (2005) An unusual cause of rectal bleeding. Br J Radiol 78:373–375
Kandpal H, Sharma R, Srivastava DN et al (2007) Diffuse cavernous haemangioma of colon: magnetic resonance imaging features. Report of two cases. Australas Radiol 51:B147–B151
Wang AY, Ahmad NA (2007) Diffuse cavernous hemangioma of the colon and rectum. Clin Gastroenterol Hepatol 5:A25–A26
Londono-Schimmer EE, Ritchie JK, Hawley PR (1994) Coloanal sleeve anastomosis in the treatment of diffuse cavernous haemangioma of the rectum: long-term results. Br J Surg 81:1235–1237
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
Djouhri H, Arrive L, Bouras T et al (1998) MR imaging of diffuse cavernous hemangioma of the rectosigmoid colon. AJR Am J Roentgenol 171:413–417
Gottlieb K, Coff P, Preiksaitis H et al (2008) Massive hemorrhage in pregnancy caused by a diffuse cavernous hemangioma of the rectum—EUS as imaging modality of choice. Medscape J Med 10:206–207
Coppa GF, Eng K, Localio SA (1984) Surgical management of diffuse cavernous hemangioma of the colon, rectum and anus. Surg Gynecol Obstet 159:17–22
Jeffery PJ, Hawley PR, Parks AG (1976) Colo-anal sleeve anastomosis in the treatment of diffuse cavernous haemangioma involving the rectum. Br J Surg 63:678–682
Catania G, Cardi F, Puleo C et al (2001) Long-term results after a low anterior resection with mucosectomy and colo-anal sleeve anastomosis for a diffuse cavernous haemangioma of the rectum. Chir Ital 53:107–114
Wang CH (1985) Sphincter-saving procedure for treatment of diffuse cavernous hemangioma of the rectum and sigmoid colon. Dis Colon Rectum 28:604–607
Hasegawa H, Teramoto T, Watanabe M et al (1996) Diffuse cavernous hemangioma of the rectum: MR imaging with endorectal surface coil and sphincter-saving surgery. J Gastroenterol 31:875–879
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H. T. Wang and X. H. Gao contributed equally to this work.
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Wang, H.T., Gao, X.H., Fu, C.G. et al. Diagnosis and Treatment of Diffuse Cavernous Hemangioma of the Rectum: Report of 17 Cases. World J Surg 34, 2477–2486 (2010). https://doi.org/10.1007/s00268-010-0691-1
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DOI: https://doi.org/10.1007/s00268-010-0691-1