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Schabl L, Connelly T, Steele S, Kessler H. Giant rectal vascular malformation: a rare differential diagnosis in rectal bleeding. BMJ Case Rep 2023; 16:e256038. [PMID: 37770238 PMCID: PMC10546121 DOI: 10.1136/bcr-2023-256038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Investigations in a woman with prolonged symptoms of laxative-resistant constipation and recurrent rectal bleeding revealed a giant rectal vascular malformation. Colonoscopy and MRI were performed to rule out malignancy and determine differential diagnoses. Repeated tests were necessary due to inconclusive results. After a definite diagnosis, image-guided, transcutaneously administered sclerotherapy was used. The intervention and postoperative course were uneventful. A minimally invasive procedure relieved symptoms and improved quality of life.
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Affiliation(s)
- Lukas Schabl
- Department of Colorectal Surgery, Cleveland Clinic Main Campus Hospital, Cleveland, Ohio, USA
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tara Connelly
- Department of Pediatric Surgery, King's College Hospital, London, UK
| | - Scott Steele
- Department of Colorectal Surgery, Cleveland Clinic Main Campus Hospital, Cleveland, Ohio, USA
| | - Hermann Kessler
- Department of Colorectal Surgery, Cleveland Clinic Main Campus Hospital, Cleveland, Ohio, USA
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Bitar R, Ayoade O, Yekula A, Reddy V, Pantel H, Nassiri N. Direct stick embolization of a rectal venous malformation via transanal minimally invasive surgery. J Vasc Surg Cases Innov Tech 2023; 9:101124. [PMID: 37427040 PMCID: PMC10323409 DOI: 10.1016/j.jvscit.2023.101124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/26/2023] [Indexed: 07/11/2023] Open
Abstract
Rectal venous malformations (VMs) are rare clinical entities with variable patterns of presentation. Treatment requires unique, targeted strategies based on the symptoms, associated complications, and location, depth, and extent of the lesion. We present a rare case of a large, isolated rectal VM treated by direct stick embolization (DSE) using transanal minimally invasive surgery (TAMIS). A 49-year-old man had presented with a rectal mass incidentally detected on computed tomography urography. Magnetic resonance imaging and endoscopy revealed an isolated rectal VM. Elevated D-dimer levels concerning for localized intravascular coagulopathy warranted the use of prophylactic rivaroxaban. To avoid invasive surgery, DSE using TAMIS was performed successfully without complications. His postoperative recovery was uneventful, aside from a self-limiting and expected course of postembolization syndrome. To the best of our knowledge, this is the first reported case of TAMIS-assisted DSE of a colorectal VM. TAMIS shows promise for more widespread use in the minimally invasive, interventional management of colorectal vascular anomalies.
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Affiliation(s)
- Ryan Bitar
- Division of Interventional Radiology, Department of Radiology, Yale University School of Medicine, New Haven, CT
| | - Oluwaseun Ayoade
- Division of Colorectal Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Anudeep Yekula
- Division of Colorectal Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Vikram Reddy
- Division of Colorectal Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Haddon Pantel
- Division of Colorectal Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Naiem Nassiri
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
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Huang Y, Zhuang P, Chen G, Huang Y, Dong K, Xiao X, Zheng S, Sun S. Clinical Characteristics and Management of Colorectal Vascular Malformation in Children: A Retrospective Study of 23 Cases. Eur J Pediatr Surg 2022. [PMID: 35963243 DOI: 10.1055/s-0042-1751222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The objective of this study is to summarize the clinical characteristics and management of rare diseases of colorectal vascular malformation (CRVM) in children. METHODS We retrospectively analyzed the clinical data of CRVM patients admitted to the Children's Hospital of Fudan University from 2004 to 2019. RESULTS A total of 23 cases (16 males, 7 females) were enrolled. The median age of symptom onset was 1.4 years. Hematochezia and anemia were cardinal symptoms. Fourteen patients (60.9%) were misdiagnosed as anal fissures (n = 4), internal hemorrhoids (n = 3), rectal polyps (n = 2), inflammatory bowel disease (n = 2), portal hypertension (n = 2), and Meckel's diverticulum (n = 1), respectively. The average time from symptom onset to diagnosis was 4.5 ± 4.4 years. Other vascular malformations were detected in eight patients (34.8%). All patients showed a positive anomalous vascular image on contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI). The sensitivity of colonoscopy in the diagnosis of CRVM was 82.6% (19/23). A total of 21 patients underwent a modified Soave procedure. The lesions were mostly restricted to the colorectum and showed transmural diffuse distribution, with an average length of 20 ± 5.4 cm. Two patients (9.5%) experienced surgical complications. Bloody stools reappeared in two patients (9.5%), and colonoscopy showed abnormal angiogenesis at the anastomotic site, which were cured by sclerotherapy and/or electrocautery. The median follow-up time was 78 months. Bloody stools were absent at the last time of follow-up, and hemoglobin was in the normal range for all patients. CONCLUSION The identification of CRVM in children often is delayed. Colonoscopy, CT, and MRI are essential in making the correct diagnosis. The modified Soave procedure is safe and feasible to treat CRVM in children. Endoscopic sclerotherapy and/or electrocautery can be used for residual lesions.
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Affiliation(s)
- Yanbing Huang
- Department of Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Peijun Zhuang
- Department of Anesthesiology, Children's Hospital of Fudan University, Shanghai, China
| | - Gong Chen
- Department of Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Yanlei Huang
- Department of Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Kuiran Dong
- Department of Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Xianmin Xiao
- Department of Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Shan Zheng
- Department of Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Song Sun
- Department of Surgery, Children's Hospital of Fudan University, Shanghai, China
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Krizzuk D, Cotesta M, Galiffa G, Peluso I, Falbo F, Biancucci A, Puscio S, Michelotto C, Pasecinic C, Montalto GM, Sammartino F. Polypoid arteriovenous malformation of the rectum: A case report. Front Surg 2022; 9:924801. [PMID: 35910477 PMCID: PMC9336678 DOI: 10.3389/fsurg.2022.924801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIntestinal arteriovenous malformation is an abnormal connection between arteries and veins that bypasses the capillary system and may be a cause of significant lower gastrointestinal bleeding. On endoscopy, arteriovenous malformations are usually flat or elevated, bright red lesions. Overall, rectal localization of arteriovenous malformations is rare. The same may be said about polypoid shape arteriovenous malformations. Herein, we present a case of a large rectal polypoid arteriovenous malformations.MethodsClinical, diagnostic, and treatment modalities of the patient were reviewed. Pre- and post-operative parameters were collected and analyzed. The clinical English literature is also reviewed and discussedResultsA 60-year-old female patient was admitted to our emergency department for rectorrhagia and anemia. Rectoscopy revealed a polypoid lesion in the rectum and the biopsy showed fibrosis, necrosis areas, and hyperplastic glands. A total body contrast-enhanced computed tomography (CT) was performed revealing a parietal pseudonodular thickening with concentric growth and contrast enhancement, extending for about 53 mm. The mass wasn't removed endoscopically due to concentric growth, sessile implant, and submucosal nature. The patient underwent an uneventful laparoscopic anterior rectal resection. The postoperative hospitalization was free of complications. Histology showed the presence of a polypoid AVM composed of dilated arteries, veins, capillaries, and lymphatics, engaging the submucosa, muscularis, and subserosa layer.ConclusionAfter a review of the current English literature, we found only one case of rectal polypoid AVM. The scarcity of documented cases encumbers optimal diagnostic and treatment approaches.
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Affiliation(s)
- Dimitri Krizzuk
- Department of General and Minimally-Invasive surgery, Aurelia Hospital, Rome, Italy
- Correspondence: Dimitri Krizzuk
| | - Maria Cotesta
- Department of General and Minimally-Invasive surgery, Aurelia Hospital, Rome, Italy
- Department of general surgery, Policlinico Tor-Vergata University, Rome, Italy
| | - Giampaolo Galiffa
- Department of General and Minimally-Invasive surgery, Aurelia Hospital, Rome, Italy
| | - Ilaria Peluso
- Department of General and Minimally-Invasive surgery, Aurelia Hospital, Rome, Italy
- Department of general surgery, Policlinico Tor-Vergata University, Rome, Italy
| | - Francesco Falbo
- Department of General and Minimally-Invasive surgery, Aurelia Hospital, Rome, Italy
| | - Andrea Biancucci
- Department of General and Minimally-Invasive surgery, Aurelia Hospital, Rome, Italy
| | - Sara Puscio
- Department of General and Minimally-Invasive surgery, Aurelia Hospital, Rome, Italy
- Department of general surgery, Policlinico Tor-Vergata University, Rome, Italy
| | - Chiara Michelotto
- Department of General and Minimally-Invasive surgery, Aurelia Hospital, Rome, Italy
- Department of general surgery, Policlinico Tor-Vergata University, Rome, Italy
| | - Carolina Pasecinic
- Department of General and Minimally-Invasive surgery, Aurelia Hospital, Rome, Italy
| | | | - Francesco Sammartino
- Department of General and Minimally-Invasive surgery, Aurelia Hospital, Rome, Italy
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Muniandy J, Chan KK, Bakin S. Rectal Vascular Malformation. J Gastrointest Surg 2021; 25:2715-2717. [PMID: 33834378 DOI: 10.1007/s11605-021-05002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/25/2021] [Indexed: 01/31/2023]
Affiliation(s)
| | - Koon Khee Chan
- Department of Surgery, Sultanah Aminah General Hospital, Johor Bahru, Malaysia
| | - Salinawati Bakin
- Department of Radiology, Sultanah Aminah General Hospital, Johor Bahru, Malaysia
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