Erkan Gülbanu, Alagõzlü Hakan, Memiş Leyla, Tuncer Candan
Departments of Gastroenterology and Pathology, School of Medicine, Gazi University, Ankara.
Turk J Gastroenterol. 2008 Dec;19(4):271-5.
Cavernous hemangiomas are rare lesions of the colon that usually present with painless, recurrent bleeding. Hemangiomas can be capillary or cavernous type, and 80% of rectal hemangiomas are cavernous type. Ulcerative colitis is an inflammatory disorder that affects the rectum and, occasionally, the whole colon. Diarrhea, rectal bleeding and mucous discharge characterize ulcerative colitis. We present a 61-year-old man with painless rectal bleeding due to a solitary cavernous hemangioma of the rectum. He had been diagnosed with distal type ulcerative colitis in 2003. He was asymptomatic under mesalazine treatment until May 2005, when he presented with new onset bright red rectal bleeding and mucous discharge, despite still defecating normal stools once a day. Rectosigmoidoscopic examination revealed mucosal hyperemia, edema, granularity, and a hyperemic, friable mass lesion 5x4 cm in diameter in the rectum. Following excision, histopathologic examination of the mass was consistent with cavernous hemangioma. There was a six-month period between the rectosigmoidoscopy in which the cavernous hemangioma (5x4 cm in diameter) was detected and the former rectosigmoidoscopy with no reported hemangioma. Thus, this was considered a rapidly growing cavernous hemangioma. Intralesional microhemorrhages may cause rapid enlargement of the hemangiomas. Ulcerative colitis is characterized by inflammation, which may interfere with vascular integrity and augment intralesional microhemorrhage. We postulate that the inflammatory background of ulcerative colitis may have accelerated intralesional hemorrhage and growth of this coincidental rectal cavernous hemangioma. To the best of our knowledge, this is the only case of this sort in the literature.
海绵状血管瘤是结肠的罕见病变，通常表现为无痛性反复出血。血管瘤可为毛细血管型或海绵状型，80%的直肠血管瘤为海绵状型。溃疡性结肠炎是一种炎症性疾病，累及直肠，偶尔也累及整个结肠。腹泻、直肠出血和黏液便为溃疡性结肠炎的特征。我们报告一例61岁男性，因直肠孤立性海绵状血管瘤出现无痛性直肠出血。他在2003年被诊断为远端型溃疡性结肠炎。在美沙拉嗪治疗下他一直无症状，直到2005年5月，尽管仍每天排便一次正常大便，但他出现了新的鲜红色直肠出血和黏液便。直肠乙状结肠镜检查显示黏膜充血、水肿、颗粒状，直肠内有一个直径5×4 cm的充血、质脆的肿块病变。切除后，肿块的组织病理学检查与海绵状血管瘤一致。在检测到直径5×4 cm的海绵状血管瘤的直肠乙状结肠镜检查与之前未报告有血管瘤的直肠乙状结肠镜检查之间有6个月的间隔期。因此，这被认为是一个快速生长的海绵状血管瘤。瘤内微出血可能导致血管瘤迅速增大。溃疡性结肠炎的特征是炎症，这可能会干扰血管完整性并增加瘤内微出血。我们推测溃疡性结肠炎的炎症背景可能加速了这个巧合出现的直肠海绵状血管瘤的瘤内出血和生长。据我们所知，这是文献中唯一此类病例。
