Diagnosis and treatment of colorectal vascular malformation in children

Abstract

Objective To explore the clinical features and optimal treatments of colorectal vascular malformation in children. Methods From Jan.2010 to Feb.2014, a total of 14 patients with colorectal vascular malformation were recruited. Clinical manifestations, imaging examinations, surgical treatments and outcomes were analyzed. The ratio of boy and girl was 3.7∶1. The mean age of onset was 1.5 years. The average time of delay in diagnodis was 4.1 years. There were independent diseases (n=11) and Klippel-Trenaunay syndrome (n=3). Aggravated rectal bleeding and anemia were typical manifestations. The preoperative daignosis was made by colorectal ultrasound and colonoscopy. And computed tomography angiography (CTA, n=13) and MR angiography (MRA, n=1) were performed. Colonoscopy revealed that there was a distinct boundary between lesion and normal tissue. Mucosal hyperemia, edema and fuzzy vascular network were present in 13 cases. And 1 case had purple swelling of various sizes. The procedures included transabdominal Soave (n=12), ligation of abnormal repeated vessels (n=1) and laparoscopic exploration and transanal Soave (n=1). Results The mean postoperative hospitalization stay was 15 (4-25) days. Anal dilation started from a mean time of 20 (14-25) days. Follow-ups were conducted by outpatient visits and telephone interviews during a mean period of 16 months. Four patients suffered hemafecia and two of them had bloodshot in stool occasionally. One case of hip infection was cured after antibiotics and local incision with drainage therapy. One patient became lost to follow-up. All blood routine tests showed normal hemoglobin level. Conclusions The combined use of colorectal ultrasound, CTA and colonoscopy can define the severity of vascular malformation and prevent its misdiagnosis. And transabdominal Soave procefure may completely and safely remove the lesion and cure or improve hemafecia effectively. Key words: Vascular malformations; Colon; Rectum; Diagnosis; Digestive system surgical procedures