Catania G, Cardì F, Puleo C, Catalano F, Iuppa A
Dipartimento di Chirurgia, Università degli Studi di Catania, Sezione di Chirurgia Generale ed Oncologica, Cattedra di Chirurgia Generale, Azienda Ospedali Vittorio Emanuele II, Ferrarotto, S. Bambino, Catania.
Chir Ital. 2001 Jan-Feb;53(1):107-14.
Diffuse cavernous hemangioma of the rectum is an unusual lesion. We reporting the case of an 18-year-old man with a rectal cavernous hemangioma in whom recurrent rectal bleeding and marked anemia were thought to be caused by his co-existing internal hemorrhoids. This resulted in a 2-year delay in reaching the correct diagnosis. Digital rectal examination revealed a walnut-sized, wide-based, elastic, soft mass 3 cm proximal to the anal verge. Colonoscopy revealed a bluish, submucosal lesion with superficial capillary dilatation at the same site. Arteriography demonstrated vascular tumours in the territory of the right hypogastric artery and the superior rectal artery. In 1972, Parks and co-workers described resection and colo-anal sleeve anastomosis as an alternative operation in the treatment of this rare malformation. We will describe the clinical presentation, diagnosis, and long-term results in a patient with this condition managed with this surgical technique. The patient has done well without any recurrence of rectal bleeding for over 10 years since his operation. Resection with a colo-anal sleeve anastomosis offers major advantages such as a lower risk of intraoperative bleeding, no risk of damaging the pelvic nerves, sparing of continence and avoidance of a permanent colostomy. It should therefore be considered the treatment of choice for this uncommon condition.
直肠弥漫性海绵状血管瘤是一种罕见的病变。我们报告一例18岁男性直肠海绵状血管瘤病例，其反复直肠出血和严重贫血被认为是由并存的内痔所致。这导致正确诊断延迟了2年。直肠指检发现距肛缘3 cm处有一个核桃大小、基底较宽、有弹性的柔软肿物。结肠镜检查显示同一部位有一个蓝色的黏膜下病变，伴有浅表毛细血管扩张。动脉造影显示右下腹动脉和直肠上动脉供血区域有血管肿瘤。1972年，帕克斯及其同事描述了切除及结肠肛管套叠吻合术作为治疗这种罕见畸形的一种替代手术。我们将描述采用这种手术技术治疗的该病例的临床表现、诊断及长期结果。该患者自手术以来10多年情况良好，未再出现直肠出血。结肠肛管套叠吻合术切除具有诸多主要优点，如术中出血风险较低、无损伤盆腔神经的风险、保留控便功能以及避免永久性结肠造口。因此，对于这种不常见的疾病，应将其视为首选治疗方法。
