ROLE OF VENOUS SCLEROSIS THROUGH EMBOLIZATION IN THE TREATMENT OF ANORECTAL VASCULAR MALFORMATION

Case Presentation A 5-year-old female patient presented with small amounts of blood in her stool since the first months of life. At age 3, her mother sought medical attention due to increased bleeding, which necessitated blood transfusions. A colonoscopy revealed submucosal bluish bulges in the rectum. Pelvic computed tomography (CT) showed circumferential thickening of the rectal wall with minimal enhancement and calcifications (phleboliths), consistent with venous malformation. Magnetic resonance imaging (MRI) demonstrated mild, gradual enhancement of the anorectal wall extending to the upper third of the rectum, along with multiple serpiginous structures in the perirectal fat, confirming the diagnosis of vascular malformation (VM). Conservative treatment with sclerotherapy via interventional radiology was chosen. The patient underwent partial embolization through portal venous access with the injection of lipiodol, polidocanol, and bleomycin into branches of the inferior mesenteric vein and superior rectal vein. Follow-up showed a significant reduction in episodes of hematochezia, with no further need for transfusions.

Discussion Vascular malformations of the gastrointestinal tract are among the causes of gastrointestinal bleeding, requiring differential diagnosis from rectal hemangiomas. They are classified based on histological components and flow characteristics. Most cases are found in the colon or small intestine, with rectal involvement being rare. The main symptom of rectal vascular malformations is anal bleeding associated with anemia. MRI is the preferred imaging modality to define the extent of the lesion and its relationship to adjacent structures. CT, while less specific, is useful for identifying thrombotic foci and calcifications. Among therapeutic options, vascular embolization has proven to be an effective alternative to surgery, particularly in fragile or high-risk patients. Embolization can be repeated if recurrence occurs, and symptom control can be achieved quickly, as demonstrated in this case.

Conclusion Diffuse rectal vascular malformations are rare, and early diagnosis is crucial for implementing appropriate treatment. Vascular embolization is a viable and safe alternative in cases where clinical conditions or anatomical site constraints make surgery challenging.

 

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Artikel online veröffentlicht:
25. April 2025