Diffuse Cavernous Hemangioma of the Colon and Rectum

Abstract

H r 40-year-old man was referred to our clinic for evaluation of long-standing, intermittent hematochezia, which was decribed as painless bright red blood per rectum that occurred with owel movements. Past medical history was significant for a blood ransfusion at the age of 13 for rectal bleeding. Physical examinaion was significant for spider angiomas on the chest. Laboratory esting revealed a hemoglobin level of 12.9 g/dL and MCV of 78 fL. colonoscopy was performed, and subsequently a magnetic resnance image of the abdomen and pelvis was obtained. Colonoscopy (Figure A) revealed multiple confluent red-purple reas, suggestive of dilated vascular structures, extending from the ectum to 45 cm proximally. T2-weighted, coronal magnetic resnance images of the pelvis (Figure B) revealed circumferential hickening and increased signal in the distal sigmoid colon (Figure , thick arrows) and entire rectum (Figure B, thin arrows), which ossessed dilated vessels and phleboliths. Similar findings were resent throughout the subcutaneous tissues of the penis. These ndings were consistent with colonic hemangiomatosis. The paient subsequently underwent left hemicolectomy with colo-anal nastomosis. Surgical pathology confirmed the diagnosis of difuse cavernous hemangioma involving the distal colon and rectum ith marked, focal submucosal hemorrhage and multiple organizng thrombi involving the submucosa, serosa, and mesenteric fat Figure C). The patient continues to do well 3 years after the urgery without recurrent hematochezia. Colonic hemangiomas are rare, nonmalignant lesions that arise rom the submucosal vascular plexuses, as a result of embryonic equestration of mesodermal tissue. Hemangiomas, histologically istinct from telangiectasias and angiodysplasias, may be classified s capillary, cavernous, or mixed.1,2 Cavernous hemangiomas, hich comprise 70% of colonic hemangiomas, may occur as part f multisystemic or diffuse gastrointestinal angiomatosis, with ectosigmoid as the most common site of occurrence.2,3 Colonic hemangiomas can present as anemia, hematochezia, nd even massive hemorrhage. Characteristic endoscopic findngs are of soft, dilated, easily collapsible submucosal masses, anging in color from deep wine to plum. A biopsy of these esions should be performed with caution because massive leeding can occur. Complete surgical excision of these lesions ith a sphincter-saving procedure is the treatment of choice in ymptomatic cases.2,3