Komekami Yusuke, Konishi Fumio, Makita Kohzoh, Mijin Toma, Onogawa Atsushi, Chochi Takeshi, Lee Chunyong, Yoshida Takayoshi, Maeda Tooru, Mitsusada Makoto, Hasegawa Shunji
Department of Surgery, Nerima Hikarigaoka Hospital, 2-11-1, Hikarigaoka, Nerima-ku, Tokyo, 179-0072, Japan.
Department of Radiology, Nerima Hikarigaoka Hospital, 2-11-1, Hikarigaoka, Nerima-ku, Tokyo, 179-0072, Japan.
Clin J Gastroenterol. 2016 Feb;9(1):22-6. doi: 10.1007/s12328-016-0629-8. Epub 2016 Feb 16.
A 38-year-old male with no past history of illnesses visited the out-patient clinic of Nerima Hikarigaoka Hospital complaining of dizziness and persistent anal bleeding. There was a significant anemia on a blood test and colonoscopy showed a thrombus in a markedly swollen internal hemorrhoid. Contrast-enhanced computed tomography (CT) showed a poorly demarcated area with early face enhancement on the right side of the rectum and anal canal. Based on these findings, an arterio-venous malformation (AVM) of the rectum was suspected. Abdominal angiography showed abnormal vessels receiving a blood supply from the bilateral superior rectal arteries. We suspected that the AVM in the rectum was the cause of the hemorrhage from the internal hemorrhoid, and therefore performed embolization of the AVM. Thereafter, the hemorrhage from the internal hemorrhoid stopped completely and the anemia improved to the normal level, without the need for treatment for the internal hemorrhoid. Colonoscopy performed 6 months after embolization showed shrinkage of the internal hemorrhoid. To the best of our knowledge, there are no reports stating a relationship between rectal AVM and internal hemorrhoids. However, we consider that contrast-enhanced CT can be used to detect vessel abnormalities related to severe bleeding of the internal hermorrhoids in patients with internal hemorrhoids and severe anemia.
一名38岁无既往病史的男性因头晕和持续性肛门出血前往练马日向丘医院门诊就诊。血液检查显示有明显贫血，结肠镜检查发现一个明显肿大的内痔中有血栓。增强计算机断层扫描（CT）显示直肠和肛管右侧有一个边界不清、早期强化的区域。基于这些发现，怀疑为直肠动静脉畸形（AVM）。腹部血管造影显示有异常血管接受来自双侧直肠上动脉的血液供应。我们怀疑直肠AVM是内痔出血的原因，因此对AVM进行了栓塞治疗。此后，内痔出血完全停止，贫血改善至正常水平，无需对内痔进行治疗。栓塞治疗6个月后进行的结肠镜检查显示内痔缩小。据我们所知，尚无关于直肠AVM与内痔之间关系的报道。然而，我们认为增强CT可用于检测内痔伴严重贫血患者与内痔严重出血相关的血管异常。
