CAVERNOUS COLORECTAL HEMANGIOMA: A CASE REPORT

Case Presentation A 23-year-old female patient, obese, with a history of hemorrhoidal disease since the age of 4, presented with hematochezia, chronic proctalgia, and symptomatic anemia, requiring multiple blood transfusions. Initial colonoscopy suggested active proctocolitis. Treatment for ulcerative colitis was initiated with prednisone, mesalazine, and azathioprine, but with no improvement and normal rectal and sigmoid biopsies. A second colonoscopy revealed an extensive cavernous hemangioma from the distal sigmoid to the anal canal and hemorrhoidal plexus. An abdominoperineal amputation of the rectosigmoid and terminal colostomy were performed. Biopsy of the specimen confirmed the diagnosis. The patient had a good immediate postoperative recovery, and during a follow-up consultation two months later, she showed good healing, adaptation to the ostomy, and no signs of recurrence.

Discussion Cavernous hemangioma of the rectosigmoid is a rare benign vascular tumor, typically affecting young patients between the ages of 5 and 25. It often presents with recurrent, painless rectal bleeding. Due to its rarity, it is commonly misdiagnosed as hemorrhoids, proctocolitis, or other pathologies. Colonoscopy is essential for diagnosis, with typical findings of multiple tortuous and dilated blood vessels. Thrombosis of these vessels can lead to ischemia of the rectal wall, resembling colitis. Magnetic resonance imaging can aid in diagnosis and assessment of the extent of invasion of adjacent structures, the anal canal, and the sphincter. The only treatment that controls bleeding is complete surgical resection with preservation of the anal sphincter whenever possible. Although permanent colostomy is undesirable, especially in young patients, abdominoperineal amputation of the rectosigmoid is necessary if the lesion extends to the anal canal and perineum. Non-surgical techniques such as sclerotherapy and selective embolization angiography can control acute bleeding and treat small lesions, but recurrence is high.

Conclusion Colorectal cavernous hemangioma is a rare pathology, with delayed diagnosis due to its presentation being similar to more common diseases. As seen in the presented case, many young patients end up undergoing abdominoperineal amputation with irreversible ostomy. Thus, studies on alternative therapeutic approaches that preserve the anal sphincter in cases with perineal involvement are needed.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025