Cavernous, arteriovenous, and mixed hemangioma–lymphangioma of the rectosigmoid: rare causes of rectal bleeding—case series and review of the literature

Abstract

Therapy is typically delayed by several years in these patients due to erroneous diagnosis and failed treatment of hemorrhoids and inflammatory bowel disease. Relative to hemangiomas, lymphangiomas of the rectosigmoid are even more rare and when symptomatic, present with rectal bleeding and pelvic pain.

Colonic venous malformation and portal hypertension: association, management, and review of the literature

“…[2, is an important reminder that hemorrhoids presenting in infancy may be the form fruste of a colo-rectal venous malformation or portal venous hypertension. [4][5][6][7][8] Second, there appears to be a natural progression of lipomatous lymphovascular malformation to a venous malformation, [1,2,5,[8][9][10] and especially in the setting of symptoms resection is appropriate. [5,8,[11][12][13][14] Third, this particular case also demonstrated the development of extra hepatic portal venous occlusion between the initial identification of a colorectal venous malformation and the development of portal hypertension.…”

“…[1][2][3][4] With the growing body of literature surrounding complex vascular malformations and the development of Vascular Anomaly Centers, there is now an increasing awareness of the natural history of complex colorectal vascular anomalies, [5] including the relationship between lipomatous soft tissue hypertrophy with lymphatic and venous malformations. [2, is an important reminder that hemorrhoids presenting in infancy may be the form fruste of a colo-rectal venous malformation or portal venous hypertension.…”

Beyond hepatic hemangiomas: the diverse appearances of gastrointestinal and genitourinary hemangiomas

“…Capillary hemangiomas are rarely symptomatic and are usually discovered incidentally or at autopsy, although they may cause melena [39,61]. In contrast, cavernous hemangiomas, comprising 80% of all rectosigmoid hemangiomas [65], present at a young age and manifest as painless rectal hemorrhage in up to 90% of cases, which can be massive and life threatening [39]. Pregnancy can increase the likelihood of hemorrhage [66].…”

“…Serpiginous blood vessels supplying the hemangioma are often seen in the perirectal fat [64]. Fluid-fluid levels may be seen in hemangiomas but can also indicate a lymphatic malformation, either as an alternative diagnosis or as a combined-type lesion [65,68].…”

“…Although sphincter-preserving surgical methods are preferred [70], more extensive operative intervention may be required, depending on the extent of involvement and presence of perirectal invasion. Radiation, laser therapy, sclerosing agents, and embolization have also been utilized [63,65,68].…”