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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 3  |  Issue : 1  |  Page : 63-65

Endoscopic ultrasound for cavernous hemangioma of rectum


1 Department of Gastroenterology, Jaswant Rai Specialist Hospital, Meerut, PIN - 250 001, Uttar Pradesh, India
2 Department of Cytopathology, Jaswant Rai Specialist Hospital, Meerut, PIN - 250 001, Uttar Pradesh, India

Date of Submission27-Sep-2013
Date of Acceptance14-Dec-2013
Date of Web Publication14-Feb-2014

Correspondence Address:
Malay Sharma
Department of Gastroenterology, Jaswant Rai Specialist Hospital, Meerut, PIN - 250 001, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2303-9027.127127

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  Abstract 

Lower gastrointestinal (GI) bleed due to hemangioma in rectum is an uncommon problem. A 19-year-old female patient presented with history of recurrent episodes of lower GI bleeding 1-2 times/month for last 3 years. At the time of hospitalization her vital signs were normal and rectal examination revealed frank blood. Investigations revealed a hemoglobin level of 8.9 g/dL and normal coagulation parameters. Colonoscopy showed bluish reddish elevated nodular lesions limited to distal rectum. Magnetic resonance imaging and endoscopic ultrasound showed cavernous hemangioma.

Keywords: c0 avernous hemangioma, endoscopic ultrasound, rectum, female


How to cite this article:
Sharma M, Adulqader A, Shifa R. Endoscopic ultrasound for cavernous hemangioma of rectum . Endosc Ultrasound 2014;3:63-5

How to cite this URL:
Sharma M, Adulqader A, Shifa R. Endoscopic ultrasound for cavernous hemangioma of rectum . Endosc Ultrasound [serial online] 2014 [cited 2019 Sep 18];3:63-5. Available from: http://www.eusjournal.com/text.asp?2014/3/1/63/127127


  Introduction Top


Lower gastrointestinal (GI) bleed due to hemangioma in rectum is an uncommon problem. The routine evaluation includes endoscopic examination where a classical appearance is seen. A hemangioma generally has a feeding and draining vessel and the collection of contrast in hemangioma helps in its identification during computed tomography (CT) scan or magnetic resonance imaging (MRI). This case reports the endoscopic ultrasound (EUS) findings of hemangioma in rectum.


  Case Report Top


A 19-year-old female patient presented with history of recurrent episodes of lower GI bleeding 1-2 times/month for last 3 years. At the time of hospitalization her vital signs were normal and rectal examination revealed frank blood. Investigations revealed a hemoglobin level of 8.9 g/dL and normal coagulation parameters. Colonoscopy showed bluish reddish elevated nodular lesions limited to distal rectum [Figure 1] and [Video 1]. MRI of rectum showed hyper intense signals in the anterior wall [Figure 2]. The radial ultrasound was able to demonstrate vascular signal in the submucosa of anterior wall of rectum [Figure 3]. Real time EUS imaging was able to trace an outflowing vessel through the left lateral wall of rectum for a distance of about 3 cm [Video 2]. Application of pulse Doppler confirmed the venous nature of the outflowing vessel [Figure 4]. Linear EUS showed a submucosal vascular lesion in the anterior wall of rectum supplied by an inflowing artery [Figure 5] and Video 3]. A biopsy of the lesion showed numerous dilated vascular spaces within lamina propria and submucosa [Figure 6]
Figure 1. Colonoscopy showed bluish reddish elevated nodular lesions limited to distal rectum. the lesion was seen in anterior wall

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Figure 2. Magnetic resonance imaging of rectum showed hyper intense signals in the anterior wall (green arrow)

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Figure 3. The radial ultrasound of rectum showed vascular signal in the submucosa of anterior wall of rectum

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Figure 4. Application of pulse Doppler confirmed the venous nature of the outflowing vessel in the anterior wall of rectum

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Figure 5. Linear endoscopic ultrasound showed a submucosal vascular lesion in the anterior wall of rectum supplied by an inflowing artery

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Figure 6. A biopsy of the lesion showed numerous dilated vascular spaces within lamina propria and submucosa

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Cavernous hemangioma is an uncommon entity responsible for <1% of lower GI bleed. Diagnosis is best established by endoscopic visualization of a blood filled hemangioma that has appearance of plum red nodules or vascular congestion. [1],[2] CT scan and MRI can also be used for diagnosis and evaluation of the extent. In this case the diagnosis was suspected by endoscopic appearance and MRI and continuous color Doppler EUS of the lesion provided additional information of presence of a vascular lesion [Figure 3], [Figure 4], [Figure 5], Videos 2 and 3]. The patient was referred for surgical resection of rectum and coloanal anastomosis.




 
  References Top

1.Stojèev Z, Maliszewski D, Paw³owska-Stojèev I, et al . Diffuse cavernous hemangioma of the rectum (DCHR) - diagnosis and treatment - Case report and review of available literature. Pol Przegl Chir 2013:85;216-8.  Back to cited text no. 1
    
2.Aktaþ E, Arda K, Çiledað N, et al . Diffuse cavernous hemangioma of the rectosigmoid colon. Turk J Gastroenterol 2012:23;308-9.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]


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