Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
Department of Radio-Diagnosis, All India Institute of Medical Sciences, New Delhi, India.
Asian J Endosc Surg. 2021 Jan;14(1):85-89. doi: 10.1111/ases.12808. Epub 2020 Jun 16.
Rectal vascular malformation is a rare disease on which few reports have been published. Here, we report the case of a 38-year-old woman who presented with severe weakness, dyspnea, and recurrent episodes of rectal bleeding. Her colonoscopy showed an extensive pigmented lesion in the lower rectum. CT angiography showed diffuse circumferential wall thickening of the rectum, perirectal fat stranding, tiny round foci of calcification, and no arterial feeders. Multiphasic MRI confirmed the diagnosis. The patient underwent a total mesorectal excision with hand-sewn coloanal anastomosis. The venous malformation was confined to the mesorectal tissue. The avascular plane between the ectodermal and mesodermal tissue was well maintained. Blood loss was 200 mL. The patient has had no recurrence of disease in the 18 months since surgery. Although total mesorectal excision is described for rectal cancer, it may be indicated for benign disease like rectal vascular malformation to achieve complete removal of the disease and to minimize intraoperative blood loss.
直肠血管畸形是一种罕见疾病，相关报道较少。本文报道了 1 例 38 岁女性，因严重乏力、呼吸困难和反复直肠出血就诊。结肠镜检查显示下段直肠有广泛色素沉着病变。CT 血管造影显示直肠弥漫性环状壁增厚、直肠周围脂肪条索状、微小圆形钙化灶，未见动脉供血。多期 MRI 明确诊断。患者行直肠系膜全切除术+手工结肠肛管吻合术。静脉畸形局限于直肠系膜组织。中胚层和外胚层组织之间的无血管平面得以很好地保留。术中失血 200 mL。术后 18 个月，患者疾病无复发。虽然直肠系膜全切除术用于直肠癌，但对于直肠血管畸形等良性疾病，为了彻底切除病变并减少术中失血，也可能适用。
