An unusual cause of rectal bleeding

Abstract

A 62-year-old man with acute onset of rectal bleeding was admitted to the hospital where he was transfused several units of blood. Similar intermittent episodes had occurred in the past since early childhood. Some 30 years ago, portal hypertension was postulated, and a splenorenal and subsequently a portocaval shunt procedure were performed. Nevertheless, the rectal bleeding episodes continued, but the patient remained in a relatively stable condition until the present admission. On physical examination, the patient showed mild abdominal distention and moderate jaundice. Digital rectal exam revealed gross blood, a sponge-like rectal wall but no palpable mass. Proctosigmoidoscopy showed large submucosal lesions with bluish discoloration. A CT scan with oral contrast and intravenous contrast was obtained with findings characteristic of the diagnosis (Figure 1). What is the diagnosis? What further studies are indicated? What is the treatment?