Wiedmann M, Halm U, Borte G, Witzigmann H
Medizinische Klink und Poliklinik II, Universität Leipzig, Germany.
Dtsch Med Wochenschr. 2002 May 24;127(21):1130-3. doi: 10.1055/s-2002-31528.
A 38-year-old patient with a history of recurrent gastrointestinal bleeding for more than 15 years was transferred for the treatment of a new onset of hematochezia and anemia. His general condition was clearly reduced.
Laboratory results showed a distinct microcytic hypochromic anemia; ferrum, ferritin, albumin, and protein were also diminished. Colonoscopy and transrectal ultrasound uncovered large hemangiomatous structures in the rectum. Digital substraction angiography of the bilateral internal iliac artery, superior and inferior mesenteric arteries including its branches showed a perirectal polypoid tumour with a discrete angiomatous structural shadow in the capillary phase. MRI of the pelvis revealed angiomatous blood vessels in the whole pararectal space and to a minor extension in the gluteal muscles.
DIAGNOSIS, TREATMENT AND COURSE: The diagnosis of cavernous hemangioma of the rectum was made and a distal mesorectal resection of the rectum including a coloanal anastomosis and double-running ileostomy was performed. 3 months later the ileostomy was reversed. There was no further bleeding and the rectal continence was normal.
In case of unclear recurrent lower gastrointestinal bleeding, with onset in the early childhood and impressive rectal varices, one has to think about the rare diagnosis of cavernous hemangioma.
一名有超过15年反复胃肠道出血病史的38岁患者因新发便血和贫血前来接受治疗。其一般状况明显较差。
实验室结果显示明显的小细胞低色素性贫血；铁、铁蛋白、白蛋白和蛋白质水平也降低。结肠镜检查和经直肠超声检查发现直肠内有大的血管瘤样结构。双侧髂内动脉、肠系膜上动脉和肠系膜下动脉及其分支的数字减影血管造影显示直肠周围有一个息肉样肿瘤，在毛细血管期有离散的血管瘤样结构阴影。骨盆磁共振成像显示整个直肠旁间隙有血管瘤样血管，在臀肌中有轻度延伸。
诊断、治疗及病程：诊断为直肠海绵状血管瘤，行直肠低位系膜切除术，包括结肠肛管吻合术和双腔回肠造口术。3个月后回肠造口术还纳。此后未再出血，直肠控便功能正常。
对于反复不明原因的下消化道出血，起病于儿童早期且伴有明显的直肠静脉曲张，必须考虑罕见的海绵状血管瘤诊断。
