GI-Associated Hemangiomas and Vascular Malformations

 

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ABSTRACT

Hemangiomas and vascular malformations of the gastrointestinal tract, rare clinical entities, present as overt or occult bleeding. They can be distributed throughout the intestinal digestive system, or present as a singular cavernous hemangioma or malformation, which is often located in the rectosigmoid region. Misdiagnosis is common despite characteristic radiographic features such as radiolucent phleboliths on plain film imaging and a purplish nodule on endoscopy. Adjunctive imaging such as computed tomography and magnetic resonance imaging are suggested as there is potential for local invasion. Endorectal ultrasound with Doppler has also been found to be useful in some instances. Surgical resection is the mainstay of treatment, with an emphasis on sphincter preservation. Nonsurgical endoscopic treatment with banding and sclerotherapy has been reported with success, especially in instances where an extensive resection is not feasible.

REFERENCES

• 1 Phillips B. Surgical cases.  London Med Gaz. 1839;  23 514-517
  PubMedGoogle Scholar
• 2 Gentry R W, Dockerty M B, Glagett O T. Vascular malformations and vascular tumors of the gastrointestinal tract.  Surg Gynecol Obstet. 1949;  88 (4) 281-323
  PubMedGoogle Scholar
• 3 Varma J D, Hill M C, Harvey L AC. Hemangioma of the small intestine manifesting as gastrointestinal bleeding.  Radiographics. 1998;  18 (4) 1029-1033
  PubMedGoogle Scholar
• 4 Lyon D T, Mantia A G. Large-bowel hemangiomas.  Dis Colon Rectum. 1984;  27 (6) 404-414
  CrossrefPubMedGoogle Scholar
• 5 Allred Jr H W, Spencer R J. Hemangiomas of the colon, rectum, and anus.  Mayo Clin Proc. 1974;  49 (10) 739-741
  PubMedGoogle Scholar
• 6 Coppa G F, Eng K, Localio S A. Surgical management of diffuse cavernous hemangioma of the colon, rectum and anus.  Surg Gynecol Obstet. 1984;  159 (1) 17-22
  PubMedGoogle Scholar
• 7 Dachman A H, Ros P R, Shekitka K M, Buck J L, Olmsted W W, Hinton C B. Colorectal hemangioma: radiologic findings.  Radiology. 1988;  167 (1) 31-34
  PubMedGoogle Scholar
• 8 Djouhri H, Arrivé L, Bouras T, Martin B, Monnier-Cholley L, Tubiana J M. MR imaging of diffuse cavernous hemangioma of the rectosigmoid colon.  AJR Am J Roentgenol. 1998;  171 (2) 413-417
  PubMedGoogle Scholar
• 9 Fishman S J, Smithers C J, Folkman J et al.. Blue rubber bleb nevus syndrome: surgical eradication of gastrointestinal bleeding.  Ann Surg. 2005;  241 (3) 523-528
  CrossrefPubMedGoogle Scholar
• 10 Fernandez-Pineda I. Vascular tumors and malformations of the colon.  World J Gastroenterol. 2009;  15 (41) 5242-5243
  CrossrefPubMedGoogle Scholar
• 11 Mulliken J B, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics.  Plast Reconstr Surg. 1982;  69 (3) 412-422
  CrossrefPubMedGoogle Scholar
• 12 Mallucci P. Vascular anomalies must be properly classified.  BMJ. 1999;  319 (7214) 919
  PubMedGoogle Scholar
• 13 Mulliken J, Young A E. Vascular Birthmarks: Hemangiomas and Vascular Malformations. Philadelphia. WB Saunders; 1988: 24-37
  Google Scholar
• 14 Marchuk D A. Pathogenesis of hemangioma.  J Clin Invest. 2001;  107 (6) 665-666
  CrossrefPubMedGoogle Scholar
• 15 Kaijser R. Uber hamangiome des tractus gastrointestinalis.  Archiv Klin Chir. 1936;  187 351-388
  PubMedGoogle Scholar
• 16 Bland K I, Abney H T, MacGregor A MC, Hawkins I F. Hemangiomatosis of the colon and anorectum: case report and a review of the literature.  Am Surg. 1974;  40 (11) 626-635
  PubMedGoogle Scholar
• 17 Chaimoff C. On the treatment of hemangioma of the rectum.  Dis Colon Rectum. 1985;  28 (8) 632
  PubMedGoogle Scholar
• 18 Borum M L. Cavernous colorectal hemangioma: a rare cause of lower gastrointestinal bleeding and a review of the literature.  Dig Dis Sci. 1997;  42 (12) 2468-2470
  CrossrefPubMedGoogle Scholar
• 19 Pohlen U, Kroesen A J, Berger G, Buhr H J. Diagnostics and surgical treatment strategy for rectal cavernous hemangiomas based on three case examples.  Int J Colorectal Dis. 1999;  14 (6) 300-303
  CrossrefPubMedGoogle Scholar
• 20 Tan M CB, Mutch M G. Hemangiomas of the pelvis.  Clin Colon Rectal Surg. 2006;  19 (2) 94-101
  Article in Thieme ConnectPubMedGoogle Scholar
• 21 Kempson R L, Fletcher C D, Evans H L, Hendrickson M R, Sibley R K. Atlas of Tumor Pathology, Third Series, Fascicle 30: Tumors of the Soft Tissues. Washington, DC: Armed Forces Institute of Pathology; 2001: 307-367
  Google Scholar
• 22 Head H D, Baker J Q, Muir R W. Hemangioma of the colon.  Am J Surg. 1973;  126 (5) 691-694
  CrossrefPubMedGoogle Scholar
• 23 Pérez C, Andreu J, Llauger J, Valls J. Hemangioma of the rectum: CT appearance.  Gastrointest Radiol. 1987;  12 (4) 347-349
  CrossrefPubMedGoogle Scholar
• 24 Rissier Jr H L. Hemangiomatosis of the intestine. Discussion, review of the literature and report of two new cases.  Gastroenterologia. 1960;  93 357-385
  CrossrefPubMedGoogle Scholar
• 25 Geschickter C F, Keasbey L E. Tumors of blood vessels.  Am J Cancer. 1935;  23 568-591
  PubMedGoogle Scholar
• 26 Cheung D S, Warman M L, Mulliken J B. Hemangioma in twins.  Ann Plast Surg. 1997;  38 (3) 269-274
  CrossrefPubMedGoogle Scholar
• 27 Blei F, Walter J, Orlow S J, Marchuk D A. Familial segregation of hemangiomatas and vascular malformations as an autosomal dominant trait: a rare genetic disorder.  Arch Dermatol. 1998;  134 718-722
  CrossrefPubMedGoogle Scholar
• 28 Takahashi K, Mulliken J B, Kozakewich H P, Rogers R A, Folkman J, Ezekowitz R A. Cellular markers that distinguish the phases of hemangioma during infancy and childhood.  J Clin Invest. 1994;  93 (6) 2357-2364
  CrossrefPubMedGoogle Scholar
• 29 Brizel H E, Raccuglia G. Giant hemangioma with thrombocytopenia. Radioisotopic demonstration of platelet sequestration.  Blood. 1965;  26 (6) 751-764
  PubMedGoogle Scholar
• 30 Hall G W. Kasabach-Merritt syndrome: pathogenesis and management.  Br J Haematol. 2001;  112 (4) 851-862
  CrossrefPubMedGoogle Scholar
• 31 Aylward C A, Orangio G R, Lucas G W, Fazio V W. Diffuse cavernous hemangioma of the rectosigmoid—CT scan, a new diagnostic modality, and surgical management using sphincter-saving procedures. Report of three cases.  Dis Colon Rectum. 1988;  31 (10) 797-802
  CrossrefPubMedGoogle Scholar
• 32 Bortz J H. Diffuse cavernous hemangioma of the rectum and sigmoid.  Abdom Imaging. 1994;  19 (1) 18-20
  CrossrefPubMedGoogle Scholar
• 33 Hsu R M, Horton K M, Fishman E K. Diffuse cavernous hemangiomatosis of the colon: findings on three-dimensional CT colonography.  AJR Am J Roentgenol. 2002;  179 (4) 1042-1044
  PubMedGoogle Scholar
• 34 Amarapurkar D, Jadliwala M, Punamiya S, Jhawer P, Chitale A, Amarapurkar A. Cavernous hemangiomas of the rectum: report of three cases.  Am J Gastroenterol. 1998;  93 (8) 1357-1359
  CrossrefPubMedGoogle Scholar
• 35 Levy A D, Abbott R M, Rohrmann Jr C A, Frazier A A, Kende A. Gastrointestinal hemangiomas: imaging findings with pathologic correlation in pediatric and adult patients.  AJR Am J Roentgenol. 2001;  177 (5) 1073-1081
  CrossrefPubMedGoogle Scholar
• 36 Oner Z, Altaca G. Diffuse cavernous rectal hemangioma—clinical appearance, diagnostic modalities and sphincter saving approach to therapy: report of 2 and a collective review of 79 cases.  Acta Chir Belg. 1993;  93 (4) 173-176
  PubMedGoogle Scholar
• 37 Wang H T, Tu Y, Fu C G et al.. Diffuse cavernous hemangioma of the rectosigmoid colon.  Tech Coloproctol. 2005;  9 (2) 145-148
  CrossrefPubMedGoogle Scholar
• 38 Nader P R, Margolin F. Hemangioma causing gastrointestinal bleeding. Case report and review of the literature.  Am J Dis Child. 1966;  111 (2) 215-222
  PubMedGoogle Scholar
• 39 Sylla P, Deutsch G, Luo J et al.. Cavernous, arteriovenous, and mixed hemangioma-lymphangioma of the rectosigmoid: rare causes of rectal bleeding—case series and review of the literature.  Int J Colorectal Dis. 2008;  23 (7) 653-658
  CrossrefPubMedGoogle Scholar
• 40 Fenoglio-Preiser C M, Pascal R R, Perzin K H. Atlas of Tumor Pathology, Second Series, Fascicle 27: Tumors of the Intestines. Washington, DC: Armed Forces Institute of Pathology; 1990: 473-483
  Google Scholar
• 41 Babcock W W, Jonas K C. Hemangioma of the colon.  Am J Surg. 1950;  80 (7) 854-859
  CrossrefPubMedGoogle Scholar
• 42 Buie L A, Swan T. Benign tumors of the colon.  Surg Clin North Am. 1929;  9 893-910
  PubMedGoogle Scholar
• 43 Sawyer C F. Hemangioma of colon.  Arch Surg. 1939;  39 987-991
  CrossrefPubMedGoogle Scholar
• 44 Stening S G, Heptinstall D P. Diffuse cavernous haemangioma of the rectum and sigmoid colon.  Br J Surg. 1970;  57 (3) 186-189
  CrossrefPubMedGoogle Scholar
• 45 Gottlieb K, Coff P, Preiksaitis H, Juviler A, Fern P. Massive hemorrhage in pregnancy caused by a diffuse cavernous hemangioma of the rectum—EUS as imaging modality of choice.  Medscape J Med. 2008;  10 (9) 206
  PubMedGoogle Scholar
• 46 Yorozuya K, Watanabe M, Hasegawa H et al.. Diffuse cavernous hemangioma of the rectum: report of a case.  Surg Today. 2003;  33 (4) 309-311
  CrossrefPubMedGoogle Scholar
• 47 Cunningham J A, Garcia V F, Quispe G. Diffuse cavernous rectal hemangioma—sphincter-sparing approach to therapy. Report of a case.  Dis Colon Rectum. 1989;  32 (4) 344-347
  CrossrefPubMedGoogle Scholar
• 48 Wang C H. Sphincter-saving procedure for treatment of diffuse cavernous hemangioma of the rectum and sigmoid colon.  Dis Colon Rectum. 1985;  28 (8) 604-607
  CrossrefPubMedGoogle Scholar
• 49 Bartoshesky L E, Bull M, Feingold M. Corticosteroid treatment of cutaneous hemangiomas: how effective? A report on 24 children.  Clin Pediatr (Phila). 1978;  17 (8) 625-638, 629–638
  CrossrefPubMedGoogle Scholar
• 50 Akyüz C, Yariş N, Kutluk M T, Büyükpamukçu M. Management of cutaneous hemangiomas: a retrospective analysis of 1109 cases and comparison of conventional dose prednisolone with high-dose methylprednisolone therapy.  Pediatr Hematol Oncol. 2001;  18 (1) 47-55
  CrossrefPubMedGoogle Scholar
• 51 Ezekowitz R AB, Mulliken J B, Folkman J. Interferon alfa-2a therapy for life-threatening hemangiomas of infancy.  N Engl J Med. 1992;  326 (22) 1456-1463
  CrossrefPubMedGoogle Scholar
• 52 Fraiberg E N, Ahmed S. Colonoscopic excision of a polypoidal cavernous hemangioma of the cecum.  Gastrointest Endosc. 1985;  31 (2) 109
  PubMedGoogle Scholar
• 53 Liang L C, Forbes N, David J, Ozick L. Endoscopic polypectomy of an unusually long polypoid colorectal cavernous hemangioma.  Gastrointest Endosc. 1998;  47 (3) 307-308
  CrossrefPubMedGoogle Scholar
• 54 Levitt R E. Colonic cavernous hemangioma.  Gastrointest Endosc. 1998;  48 (3) 337
  PubMedGoogle Scholar
• 55 Benson J M, Orlay G. Colorectal haemangioma and its relationship to haemorrhoids in childhood.  Aust N Z J Surg. 1991;  61 (7) 537-540
  CrossrefPubMedGoogle Scholar
• 56 Zurakowski J, Swiercz P, Wróblewski T et al.. Diffuse cavernous hemangioma of rectosigmoid colon treated with n-butyl-2-cyanoacrylate injections.  Endoscopy. 2008;  40 (Suppl 2) E120-E121
  Article in Thieme ConnectPubMedGoogle Scholar
• 57 Jaques A A. Cavernous hemangioma of the rectum and rectosigmoid colon.  Am J Surg. 1952;  84 (5) 507-509
  CrossrefPubMedGoogle Scholar
• 58 Hellstrom J, Hultborn K A, Engstedt L. Diffuse cavernous hemangioma of the rectum.  Acta Chir Scand. 1955;  109 (3-4) 277-283
  PubMedGoogle Scholar
• 59 Westerholm P. A case of diffuse haemagiomatosis of the colon and rectum.  Acta Chir Scand. 1967;  133 173-176
  PubMedGoogle Scholar
• 60 Demircan O, Sönmez H, Zeren S, Coşar E, Bicakci K, Ozkan S. Diffuse cavernous hemangioma of the rectum and sigmoid colon.  Dig Surg. 1998;  15 (6) 713-715
  CrossrefPubMedGoogle Scholar
• 61 Jeffery P J, Hawley P R, Parks A G. Colo-anal sleeve anastomosis in the treatment of diffuse cavernous haemangioma involving the rectum.  Br J Surg. 1976;  63 (9) 678-682
  CrossrefPubMedGoogle Scholar
• 62 Parks A G. Benign tumors of the rectum. In: Rob C, Smith R, Morgan C N, eds. Clinical Surgery. Vol 10. Abdomen and Rectum and Anus. London: Butterworths; 1966: 541-548
  Google Scholar
• 63 Londono-Schimmer E E, Ritchie J K, Hawley P R. Coloanal sleeve anastomosis in the treatment of diffuse cavernous haemangioma of the rectum: long-term results.  Br J Surg. 1994;  81 (8) 1235-1237
  CrossrefPubMedGoogle Scholar
• 64 Telander R L, Ahlquist D, Blaufuss M C. Rectal mucosectomy: a definitive approach to extensive hemangiomas of the rectum.  J Pediatr Surg. 1993;  28 (3) 379-381
  CrossrefPubMedGoogle Scholar
• 65 Huh J W, Cho S H, Lee J H, Kim H R. Large cavernous hemangioma in the cecum treated by laparoscopic ileocecal resection.  World J Gastroenterol. 2009;  15 (26) 3319-3321
  CrossrefPubMedGoogle Scholar

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