Unusual Presentation of Anal Pain and Tenesmus from Rectal Arteriovenous Malformation Successfully Treated with Ethanol Sclerotherapy

Abstract

Gastrointestinal arteriovenous malformation (AVM) is reported as one of the possible causes of intestinal bleeding, and its occurrence in the rectum is rare. We report the case of a rectal AVM patient who experienced uncommon symptoms of anal pain and tenesmus and was treated successfully with percutaneous transarterial ethanol sclerotherapy. The patient underwent routine colonoscopy with biopsy at the time of visit; however, an accurate diagnosis was difficult. Subsequent contrast-enhanced computed tomography (CT) and angiography revealed a rectal AVM emerging from the distal inferior mesenteric artery with engorged superior rectal veins. The feeding artery was catheterized, and concurrent transarterial sclerotherapy with 80% ethanol was performed. There was no major complication related to the procedure. Disappearance of AVM nidus and improvement of associated venous congestion were shown by follow-up CT. There was no recurrence of symptoms after 10 months of clinical observation. Transarterial ethanol sclerotherapy is safe and effective in treating rectal AVM and can be considered as one of the nonsurgical treatment options.

Trans-arterial embolization of a Yakes type IIb inferior mesenteric arteriovenous malformation: A case report and literature review for angio-architecture analysis

“…Six cases of embolization failure via the TA route were due to persistent or recurring symptoms in the short term [7 , 12 , 29] , deterioration of ischemia [19 , 20] , technical issues [21] , and AVM rupture after embolization [33] . Among the 9 cases of successful embolization via the TA route, our patient had frequent diarrhea, which disappeared after 6 months; 1 patient had paroxysmal abdominal pain after embolization [16] , which disappeared after a few days; and the remaining 7 patients had no complications after embolization and recovered well [11 , 13 , 27 , 32 , 34 , 35 , 40] . All 5 patients who underwent successful transvenous (TV) route embolization [10 , 14 , 26 , 28 , 31] developed no complications and recovered well ( Fig.…”

“…The curative intervention for Yakes type II AVM/AVF is complete sclerosis of the nidus using a liquid embolic such as ethanol [32] , glue (our case), foam [10] , or onyx [11 , 13 , 14 , 20] . However, the use of a liquid embolic requires experience; incomplete devascularization of the nidus can lead to persistent symptoms [29] or symptom recurrence [7] .…”

“…Considering the clarity of available images for angioarchitecture analysis, we conducted a literature review of PubMed from 1988 to 2022 using the keywords “inferior mesenteric artery,” “arteriovenous malformation,” and “fistula” and found 39 cases. After excluding those without angiography [2] , those with poor imaging quality [3] , and those with an unclear relationship between the nidus and outflow veins in imaging examinations [4 , 5] , we conducted an angioarchitecture analysis of 33 cases [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] in addition to our own (34 total cases), as listed in Table 1 .…”

Polypoid arteriovenous malformation of the rectum: A case report

“…Gastrointestinal tract AVMs are a rare disease and are reported to account for 0.8%-3% of all cases of intestinal bleeding (7). Various vascular malformations of the bowel are described, mainly: vascular ectasia/angiodysplasia, cavernous hemangioma, and AVM.…”

Rectal arteriovenous malformations with acute rectal hemorrhage: notable magnetic resonance imaging findings

“…The clinical symptoms mostly consist of painless repeated intestinal bleeding, although severe anemia may occur in severe cases. The incidence of rectal AVM with rectal bleeding is low ( 1 , 2 ). Colonoscopy is reliable for the evaluation of rectal bleeding, but rectal AVM manifests as submucosal raised lesions or bowel wall congestion, edema, erosion, and hemorrhage, similar to submucosal lesions or ulcerative colitis.…”