Diffuse cavernous hemangioma of the rectum: MR imaging with endorectal surface coil and sphincter-saving surgery

Abstract

We describe the clinical features, diagnostic procedures, and treatment of two patients with diffuse cavernous hemangioma of the rectum. Sphincter-saving operations were performed in both patients, with satisfactory results. Magnetic resonance imaging (MRI) with an endorectal surface coil, as well as a conventional body coil, was used to determine the extent of the hemangiomas. We recommend sphincter-saving surgery for the treatment of this benign disease that can cause life-threatening hemorrhage. MRI with an endorectal coil achieves higher-resolution images than conventional MRI.

Diffuse Cavernous Hemangioma of the Rectum: Report of a Case

“…The advantage of MRI is that it can provide detailed, multiplanar anatomical images, and it can also specifically detect a hemangioma and demonstrate blood flow without the need for contrast medium. Photomicrograph of the resected specimen shows diffuse hemangiomatous lesions extending from the submucosa to the subserosas Furthermore, endorectal surface coil MRI shows the five separate layers of the bowel wall and sphincter muscles more clearly than conventional body coil MRI, enhanced CT, or helical CT. 2 It also helps to assess the extent of invasion into the anal canal. Endorectal ultrasonography shows the five separate layers as does endorectal MRI; however, the success of ultrasonography seems to depend on the operator.…”

“…Endorectal ultrasonography shows the five separate layers as does endorectal MRI; however, the success of ultrasonography seems to depend on the operator. 2 Complete resection of a diffuse cavernous hemangioma is generally regarded as the only treatment that controls bleeding effectively. 1,5 Nonoperative techniques such as sclerotherapy, 5 cryosurgery, 2 and radium implantation 6 usually provide only temporary relief.…”

“…On her first visit, we suspected a hemangioma of the rectum, in consideration of her history and physical findings, since we had encountered two other patients with the same condition. 2 Physical examination revealed a pale woman with conjunctival pallor and no evidence of mucocutaneous vascular lesions. On digital examination, there was a soft circumferential mass palpable from the anal verge.…”

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

“…In the setting of a complex colorectal vascular malformation with evidence of cavernous transformation of the portal vein, we advocate careful assessment of the mesenteric circulation. If endoscopy or MR angiography [16][17][18] demonstrates sequelae of portal hypertension despite normal estimated portal pressures, we strongly recommend that the low resistance of a venous malformation should be taken into consideration. Following the removal of the VM, portal pressures should be evaluated in the event that the removal of the low-resistance circuit exposes portal hypertension.…”

Successful conservative management of diffuse cavernous hemangioma of the rectum

“…Alternative therapies, such as sclerotherapy and selective embolization, cannot control rectal bleeding because DCHR originates from the dentate line and involves all layers of the rectal wall and the rectal mesentery. In previous reports, 33 of 43 DCHR cases underwent surgery (Table 1) [1,[5][6][7][8][9]. However, surgical resection of DCHR is complicated and can cause massive intraoperative bleeding; in a few cases, intermittent postoperative rectal bleeding was reported [1,5].…”