Healy G M, Gondal F, Rutledge N, Houlihan D D, McCann J W
Department of Radiology, St Vincent's University Hospital, D04 T6F4, Dublin, Ireland.
School of Medicine, University College Dublin, D04 V1W8, Dublin, Ireland.
CVIR Endovasc. 2021 Jan 5;4(1):5. doi: 10.1186/s42155-020-00196-1.
Chronic proctalgia can have a major impact upon quality of life. There are many potential aetiologies however, in some patients no cause can be identified.
We present a patient post liver transplant with intractable proctalgia, despite multidisciplinary management including opioids, nerve blocks and surgical intervention. An underlying rectal arteriovenous malformation (AVM) was subsequently identified and successfully treated with embolotherapy. The onset of symptoms coincided with the development of inferior mesenteric vein stenosis, likely leading to engorgement of the malformation due to impaired venous outflow. Neovascularisation secondary to the liver transplant procedure may also have contributed to growth of the lesion.
This is a rare presentation of rectal AVM. These lesions can be treated with minimally invasive embolisation/sclerotherapy and should be considered in cases of unexplained proctalgia.
慢性直肠疼痛可对生活质量产生重大影响。病因众多，但部分患者病因不明。
我们报告一例肝移植术后出现顽固性直肠疼痛的患者，尽管接受了包括使用阿片类药物、神经阻滞和手术干预在内的多学科治疗。随后发现了潜在的直肠动静脉畸形（AVM），并通过栓塞治疗成功治愈。症状发作与肠系膜下静脉狭窄的发生时间一致，可能是由于静脉流出受阻导致畸形充血。肝移植手术继发的新生血管形成也可能促使病变生长。
这是直肠AVM的罕见表现。这些病变可通过微创栓塞/硬化治疗，对于不明原因的直肠疼痛病例应考虑到该病。
