Department of Surgery, Division of Liver Surgery and Portal Hypertension, Santa Casa of Sao Paulo School of Medical Sciences, Sao Paulo, Brazil.
Department of Surgery, Jackson Memorial Hospital, Miami Transplant Institute, University of Miami, 1801 NW 9th Ave - 7th floor, Miami, FL, 33136, USA.
J Gastrointest Cancer. 2021 Mar;52(1):381-385. doi: 10.1007/s12029-020-00568-9. Epub 2021 Jan 7.
Cavernous hemangiomas are congenital hamartomatous lesions that originate from mesodermal tissue composed of dilated blood vessels. Abdominal pain and palpable mass are the most common presenting symptoms. The different types of treatment for symptomatic patients remain controversial. However, surgical resection is always the most preferred method when possible. To date, there are no reports of endoscopic ultrasound-guided (EUS-guided) absolute ethanol injection as a treatment for such disease when surgery is not an option.
A 19-year-old girl with giant cavernous intra-abdominal hemangioma extending to the hepatic hilum, also affecting the gastric wall and occupying the entire supra-mesocolic cavity, initially presents with upper gastrointestinal bleeding and loss of 20 kg in 1 year (BMI = 18 kg/m). Percutaneous angiography identified a mass with arterial blood supply by the left gastric artery that was embolized. After re-bleeding, an alternative treatment with EUS-guided injection of alcohol was proposed once resection was not feasible without major risks to a young patient. This procedure was repeated 15 and 45 days after the initial treatment, with the ethanol injection of 25 cc and 15 cc, respectively. On the second and third procedure dates, there was evident regression of the hemangioma. On the third procedure, it was possible to identify all anatomic structures that were not clear on the first EUS. After 45 days of last injection, abdominal CT and EUS showed notorious regression of the lesion. Eight months later, abdominal CT showed only a remnant lesion in the hepatogastric ligament with 129 cm on volumetry (87% lower in comparison to the initial image), and the patient remains asymptomatic with BMI of 26. In the most recent follow-up CT, 4 years and 2 months after first treatment, the patient presents with a slight increase in the hemangioma-now with 183 cm on volumetry.
Transgastric EUS-guided ethanol injection in the treatment of giant intra-abdominal cavernous hemangioma can provide good outcomes without major complications and can be repeated if necessary.
海绵状血管瘤是一种先天性错构瘤性病变，起源于由扩张的血管组成的中胚层组织。腹痛和可触及的肿块是最常见的表现症状。对于有症状的患者，不同的治疗方法仍存在争议。然而，只要有可能，手术切除始终是最优选的方法。迄今为止，当手术不可行时，尚无关于内镜超声引导（EUS 引导）绝对乙醇注射作为治疗这种疾病的方法的报告。
一名 19 岁女孩患有巨大的腹腔内海绵状血管瘤，延伸至肝门，也影响胃壁并占据整个膈上腹腔，最初表现为上消化道出血和 1 年内体重减轻 20 公斤（BMI=18kg/m）。经皮血管造影显示，左胃动脉供血的肿块被栓塞。再次出血后，由于对年轻患者风险较大，无法进行切除，因此提出了 EUS 引导下注射酒精的替代治疗方法。第一次治疗后 15 天和 45 天分别进行了 25cc 和 15cc 的乙醇注射。在第二次和第三次治疗时，血管瘤明显消退。第三次治疗时，能够识别出第一次 EUS 不清楚的所有解剖结构。最后一次注射后 45 天，腹部 CT 和 EUS 显示病变明显消退。8 个月后，腹部 CT 仅显示肝胃韧带内有残留病变，体积为 129cm（与初始图像相比降低 87%），患者无症状，BMI 为 26。在最近的随访 CT 中，首次治疗后 4 年零 2 个月，患者的血管瘤略有增加-现在体积为 183cm。
经胃 EUS 引导乙醇注射治疗巨大腹腔内海绵状血管瘤可获得良好的结果，无严重并发症，如果需要，可重复进行。
