Successful Endoscopic Management of Colonic Cavernous Vascular Malformation: A Rare Cause of Hematochezia

  • FA L
  • W T
  • G X
  • et al.
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Abstract

Introduction: Vascular malformations of the gastrointestinal (GI) tract are rare entities that can present as overt or occult bleeding. We present a case of colonic vascular malformation presenting as rectal bleeding that was successfully resected endoscopically. Case Report: A 38 year old African-American male with HIV on antiretroviral therapy, prior Shigella infection, and irritable bowel syndrome presented for evaluation of 1-2 years of intermittent rectal bleeding associated with urgency and rectal pain. He denied abdominal pain or unintentional weight loss. He acknowledged anoreceptive intercourse and reported a remote family history of colon cancer in maternal grandmother. His vital signs were normal, and his physical exam was within normal limits. Laboratory studies revealed no anemia with hemoglobin 15.1 with a mean corpuscular volume of 93. Iron studies revealed iron level 70, iron saturation 19, total iron binding capacity 366, ferritin 22. Laboratory evaluation for Celiac disease and thyroid studies were normal. Clostridium Difficile PCR was negative. Colonoscopy was notable for large internal hemorrhoids and a 15 mm pedunculated polypoid lesion in the sigmoid colon. The polypoid lesion became progressively more erythematous toward the tip and contained a central umbilication which was ulcerated with overlying adherent blood and hematin at the umbilication. The polyp was completely removed with snare cautery polypectomy. There was no bleeding at end of the procedure. Histopathology revealed a submucosal vascular malformation with ulceration and reactive changes, and no evidence of Kaposi's sarcoma. He remained stable on follow-up 24 hours and two weeks after resection, without recurrent rectal bleeding or pain. Discussion: Vascular malformations of the GI tract can occur anywhere along the GI tract and are exceedingly rare causes of hematochezia. They can be associated with syndromes such as the blue rubber nevus syndrome. Most patients present with bleeding which can be associated with iron-deficiency anemia. Physical exam is often unremarkable, although cutaneous lesions can be seen. Imaging and angiography can have a role in detecting lesions, although colonoscopy is crucial in the evaluation of these lesions. They can have pinpoint areas of bleeding, with overt ulceration rarely seen. They can also be associated with mucosal edema, nodularity and vascular congestion, which can be mistaken for inflammatory bowel disease. Misdiagnosis is common with confirmation of diagnosis on pathology. Endoscopic resection with cauterization can be successful, although biopsy is not recommended given the risk of bleeding. Surgery can provide definitive treatment. At this time there, is no clear association between colonic cavernous malformations and HIV or antiretroviral therapy.

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FA, L., W, T., G, X., & SM, Q. (2017). Successful Endoscopic Management of Colonic Cavernous Vascular Malformation: A Rare Cause of Hematochezia. Colorectal Cancer: Open Access, 03(01). https://doi.org/10.21767/2471-9943.100037

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