Giant congenital malformation of the perirectal plexus in computed tomography imaging – case report.

Abstract

SummaryBackground:Congenital arteriovenous malformation (AVM) in the pelvic area is uncommon in males.Case Report:The described case is of a giant lesion of this type that caused recurrent hemorrhaging in the lower part of the gastrointestinal tract. Preliminary diagnosis of vascular pathology was made on the basis of an endoscopic examination that revealed numerous pulsating protuberances of the rectal wall, in which blood flow was identified by means of transrectal ultrasonography. Complementing the diagnostics with a CT revealed a considerable extent of malformation, as well as its morphology and anatomical relations with the surrounding tissues.Results:Following a two-year follow-up period, the malformation did not progress or demonstrate any intensification of clinical symptoms, therefore the patient continues to undergo conservative treatment.

Giant Congenital Pelvic AVM Causing Cardiac Failure, Diplegia, and Neurogenic Bladder

“…Almost 20% of the patients with pelvic AVM are asymptomatic [ 6 ]. Symptomatic patients have different presentations.…”

“…The literature has reported rare cases in which patients felt pelvic uneasiness or pelvic pain caused by local effects; rectal pain and tenesmus; genitourinary complaints, such as hematuria, hydronephrosis, hemospermia, impotence, and orchitis; and sciatic nerve pressure-induced sciatic neuralgia. [ 2 , 3 , 6 – 8 ]. Very large AVMs result in cardiac failure caused by hemodynamic changes [ 3 ].…”

“…Imaging plays a very important role in the diagnosis of pelvic AVM. Digital subtraction angiography (DSA) is considered to be the gold standard in the diagnosis and treatment of AVM [ 2 , 6 ]. Gray-scale imaging with ultrasonography and color Doppler imaging are useful for the first examination, showing and following the vascular component of the lesion.…”

“…Follow-up is recommended for patients with asymptomatic pelvic AVM, rather than treatment [ 6 ]. Surgical treatment is preferred in small lesions that have not spread to the neighboring tissues.…”

“…Surgical treatment is preferred in small lesions that have not spread to the neighboring tissues. Endovascular treatment, in conjunction with surgery or on its own, in conjunction with embolic and sclerosing agents, is the preferred therapeutic option when factors, such as intraoperative hemorrhage risk, insufficient resection of AVM, and post-surgery relapse, are considered [ 2 , 5 , 6 ]. However, relapses after embolization caused by rechannelization and neovascularization are also frequent.…”