Krizzuk Dimitri, Cotesta Maria, Galiffa Giampaolo, Peluso Ilaria, Falbo Francesco, Biancucci Andrea, Puscio Sara, Michelotto Chiara, Pasecinic Carolina, Montalto Gioacchino Maria, Sammartino Francesco
Department of General and Minimally-Invasive surgery, Aurelia Hospital, Rome, Italy.
Department of general surgery, Policlinico Tor-Vergata University, Rome, Italy.
Front Surg. 2022 Jul 14;9:924801. doi: 10.3389/fsurg.2022.924801. eCollection 2022.
Intestinal arteriovenous malformation is an abnormal connection between arteries and veins that bypasses the capillary system and may be a cause of significant lower gastrointestinal bleeding. On endoscopy, arteriovenous malformations are usually flat or elevated, bright red lesions. Overall, rectal localization of arteriovenous malformations is rare. The same may be said about polypoid shape arteriovenous malformations. Herein, we present a case of a large rectal polypoid arteriovenous malformations.
Clinical, diagnostic, and treatment modalities of the patient were reviewed. Pre- and post-operative parameters were collected and analyzed. The clinical English literature is also reviewed and discussed.
A 60-year-old female patient was admitted to our emergency department for rectorrhagia and anemia. Rectoscopy revealed a polypoid lesion in the rectum and the biopsy showed fibrosis, necrosis areas, and hyperplastic glands. A total body contrast-enhanced computed tomography (CT) was performed revealing a parietal pseudonodular thickening with concentric growth and contrast enhancement, extending for about 53 mm. The mass wasn't removed endoscopically due to concentric growth, sessile implant, and submucosal nature. The patient underwent an uneventful laparoscopic anterior rectal resection. The postoperative hospitalization was free of complications. Histology showed the presence of a polypoid AVM composed of dilated arteries, veins, capillaries, and lymphatics, engaging the submucosa, muscularis, and subserosa layer.
After a review of the current English literature, we found only one case of rectal polypoid AVM. The scarcity of documented cases encumbers optimal diagnostic and treatment approaches.
肠道动静脉畸形是动脉与静脉之间的异常连接，绕过毛细血管系统，可能是下消化道大出血的一个原因。在内镜检查中，动静脉畸形通常是扁平或隆起的鲜红色病变。总体而言，动静脉畸形的直肠定位很少见。息肉样动静脉畸形也是如此。在此，我们报告一例巨大的直肠息肉样动静脉畸形病例。
回顾了该患者的临床、诊断和治疗方式。收集并分析了术前和术后参数。还对临床英文文献进行了回顾和讨论。
一名60岁女性患者因直肠出血和贫血入住我院急诊科。直肠镜检查发现直肠有一个息肉样病变，活检显示有纤维化、坏死区域和增生性腺体。进行了全身增强计算机断层扫描（CT），显示有一个壁层假结节增厚，呈同心性生长且有对比增强，延伸约53毫米。由于同心性生长、无蒂植入和黏膜下性质，该肿物未通过内镜切除。患者接受了顺利的腹腔镜直肠前切除术。术后住院期间无并发症。组织学检查显示存在一个息肉样动静脉畸形，由扩张的动脉、静脉、毛细血管和淋巴管组成，累及黏膜下层、肌层和浆膜下层。
在回顾当前英文文献后，我们仅发现一例直肠息肉样动静脉畸形病例。文献记载病例的稀缺阻碍了最佳诊断和治疗方法的发展。
