Rectal Arteriovenous Malformation: A Report of Two Cases, Review of Literature, and Management Algorithm

Document Type : Case Report

Authors

1 Departments of Surgical Gastroenterology,Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

2 Departments of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

Abstract

Abstract
Diffuse cavernous haemangioma of rectum (DCHR) is rare in clinical practice. Rarely, DCHR may be associated with Klippel-Trenaunay syndrome and are commonly misdiagnosed, and treated as hemorrhoids. The usual presentation is with painless bleeding per rectum. Despite many diagnostic modalities available today, the correct diagnosis is difficult to arrive at. Although the management of these cases has evolved over years, it still remains a challenge for the surgeons because of the nature and extent of involvement and risk of bleeding during the surgery. The advocated surgical interventions vary from abdomino-perineal resection (APR) to sphincter preserving surgery. Recently, transarterial embolization (TAE) has been found to be useful as a nonsurgical method of treatment in select cases of DCHR. DCHR with extension upto dentate line in young patients can be managed by sphincter preserving surgery with the advent of modern staplers, avoiding the abdominoperineal resection and a permanent stoma. We present two cases of this rare entity, DCHR, managed in our department by ultralow anterior resection with stapled anastomosis, with a review of the literature emphasizing on management.

Keywords

Full Text

Background: Diffuse cavernous hemangioma of the rectum (DCHR) is very rare. Despite the many diagnostic
modalities available, achieving a correct diagnosis is difficult. Management of these cases has evolved over
the years; still, it poses a challenge because of the nature of the disease and extent of involvement. Herein
we present two cases of rectal arteriovenous malformation (AVM) managed surgically. We also review the
literature and propose a management algorithm for rectal AVM.
Case Presentation: Two young patients presented with recurrent intermittent bleeding per rectum. One of them
was misdiagnosed with a rectal polyp and underwent polypectomy without success elsewhere prior to referral
to our hospital. The other patient presented with a history of recurrent bleeding since childhood. Patients were
evaluated with colonoscopy, contrast-enhanced computed tomography, and magnetic resonance imaging as
diagnostic tools and also for localization. DCHR was noted in both patients, extending from the dentate line
up to the rectosigmoid in one patient and to the mid-sigmoid colon in the other. After preparation, both of
them were taken up for surgery. Ultra-low anterior resection with stapled coloanal anastomosis was performed
in both. One of them had an uneventful postoperative recovery; the other developed a presacral abscess with
spontaneous per rectal drainage.
Conclusion: DCHR can be successfully managed surgically without sacrificing the anal canal, avoiding a
permanent stoma. A management algorithm was proposed.

References

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Iranian Journal of Colorectal Research
Volume 10, Issue 3
September 2022
Pages 103-109

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