Rectosigmoidal manifestations of venous malformations: MR imaging findings and interdisciplinary therapeutic modalities

Abstract

The aim of this study was to identify the frequency of rectosigmoidal involvement in patients with venous malformations (VM) of the lower extremities and to demonstrate multidisciplinary therapeutic options. The medical records and magnetic resonance images (MRI) of patients with VM of the lower extremities, over a six-year period, were reviewed retrospectively in order to determine the occurrence of rectosigmoidal involvement. Vascular interventions, surgical treatments, percutaneous and hybrid (endoscopy-guided angiography) sclerotherapy and procedural complications (according to Clavien-Dindo classification) were also noted. Of the 378 patients with vascular malformation of the lower limbs, 19 patients (5%) had documented venous rectosigmoidal malformation. All of these 19 patients reported episodes of rectal bleeding, while seven patients (36.8%) also had anemia. All patients underwent endoscopy. By endoscopy, seven patients (36.8%) showed discreet changes, and 12 patients (63.2%) showed pronounced signs of submucosal VM with active (47.3%) or previous (15.7%) bleeding. Treatment was performed in all patients with pronounced findings. Six patients underwent endoscopy-guided hybrid sclerotherapy, one patient underwent endoscopic tissue removal, one patient received percutaneous sclerotherapy and one patient received a combination of transvenous embolization and hybrid sclerotherapy. Three patients required open surgery. No complications occurred after conservative treatments; however, one complication was reported after open surgery. None of the treated patients reported further bleeding and anemia at the end of the follow-up period. In this cohort, rectosigmoidal VM occurred in 5% of patients presenting with a high incidence of rectal bleeding. Percutaneous or endoscopy-guided hybrid sclerotherapy appeared to be a safe and effective alternative to surgery.

Large Anorectal Venous Malformation Treated With Microfoam Therapy

“…Methods of treatment include surgery, endoscopic sclerotherapy, and very rarely portal vein sclerotherapy. 4 Surgery is an option if the lesion can be resected completely, and the anastomosis site is disease-free. Surgical resection with anastomosis is indicated if the anal sphincter is not affected.…”

“…In properly selected cases, surgery with sphincter preservation is the treatment of choice with low anterior resection or pull-through transection techniques. 4 , 5 …”

“…In properly selected cases, surgery with sphincter preservation is the treatment of choice with low anterior resection or pull-through transection techniques. 4,5 Because of anal canal and perirectal structure involvement, we planned for endoscopic microfoam sclerotherapy. Endoscopic injection sclerotherapy has been reported as an effective treatment of small colorectal VMs.…”

“… 2 Clinical features include minimal to massive hematochezia. 3 , 4 Visualization of bluish red or red purple elevated lesions in colonoscopy is the diagnostic feature of VMs. The differential diagnosis includes hemangioma and arterial-VM.…”

Revisiting imaging features of rectosigmoid vascular malformation with emphasis on multiparametric MRI: a case report

“…Rectal bleeding is the most common indication of colonoscopy. Though colon cancer is one of the common causes of rectal bleeding, underlying vascular anomalies should be considered in the differential diagnosis [1]. According to the 2018 International Society for the Study of Vascular Anomalies (ISSVA) classification, vascular anomalies are divided into vascular tumors and malformations [2].…”