colorectal hemangioma
Introduction
Introduction to colorectal hemangioma Colorectal hemangioma is a rare congenital non-hereditary disease. As of 1984, there were only 200 cases reported in the literature. Due to its non-progressive growth characteristics, colorectal hemangioma is generally considered to be a tumor neoplasm, but a hamartoma, but there are different opinions. basic knowledge The proportion of illness: 0.001% Susceptible people: infants and young children Mode of infection: non-infectious Complications: anemia, intestinal obstruction, volvulus
Cause
Causes of colorectal hemangioma
(1) Causes of the disease
The mechanism of tissue formation of colorectal hemangioma is still unclear. It is generally believed that it originated from embryonic vascular malformation buds and is formed by tumor-like hyperplasia due to certain factors.
(two) pathogenesis
Pathology
The lesions are often multiple, some are single, located in the submucosa and muscle layer, can invade the serosal layer, especially in the peritoneal reflexes, and even invade the organs around the rectum, such as the bladder, uterus, vagina, uterus Para-tissue and pelvic wall, usually hyperplastic vascular plexus can invade the mesorectum, and can involve the sigmoid mesentery, accompanied by hyperplasia of arteriovenous vessels in the rectum and rectum. During the development of colorectal hemangioma, the intestinal wall The whole layer and the mesentery can be invaded, and the lesion often involves the lower rectum and the anal canal. In this case, it is often misdiagnosed as internal or external hemorrhoids.
Colorectal hemangioma can be accompanied by hemangioma of other organs, such as esophagus, stomach, small intestine, hemangioma of the mouth or throat, or papilloma of the skin.
Histopathological examination is characterized by the expansion of proliferating vascular masses. Many lesions, especially large lesions, can be seen with widely distributed fresh or old thrombus, accompanied by submucosal fibrosis, and can be seen in long-term thrombosis. Calcification.
2. Classification
According to the shape of blood vessels in the hemangioma can be divided into three categories:
(1) Capillary hemangioma: caused by submucosal capillary plexus, composed of proliferating non-expanded small blood vessels, the blood vessels are similar to capillaries, the tube wall is weak, the arrangement is tight, the endothelial layer is well differentiated, and there is a capsule. There is often a family history, and there are very few simple capillary hemangioma, mostly mixed with cavernous hemangioma.
(2) cavernous hemangioma: most of the lesions are located in the rectum and distal to the colon. There is usually no family history. The hemangioma is composed of dilated vascular masses. The blood vessel wall is thin, and the connective tissue in the interstitial is rare. The lesion is a typical vascular hamartoma. There are many and extensive venous lakes, often accompanied by other organ lesions, such as Klippel-Trenaunay syndrome (expressed as cutaneous hemangioma and cantharidin, lower extremity superficial varices, bone, soft tissue hypertrophy), skin blood vessels Tumors, etc., the lesions are often accompanied by thrombosis and inflammation, easy to hemorrhage, the majority of bleeding age is within 20 years of age, X-ray examination often see calcification in the lesions, such hemangioma can be divided into 3 types:
1 venous dilatation type: composed of many small tumors not exceeding 1cm in diameter;
2 polyp type: hemangioma is a polypoid into the intestine, often ulcers, bleeding and obstruction of the intestinal cavity;
3 diffuse type: most common in the rectum and sigmoid colon, single or multiple, the shape of the lesion and the range of the lesions vary, often invading a colon of 20 ~ 30cm, can cause serious symptoms in childhood.
(3) Mixed hemangioma: There are small blood vessels similar to capillary hemangioma in the tumor, and large blood vessels similar to cavernous hemangioma, which are characterized by two kinds of hemangioma.
Prevention
Colorectal hemangioma prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Colorectal hemangioma complications Complications, anemia, intestinal obstruction, intestinal torsion
Anemia, intestinal obstruction and intestinal torsion are common complications of this disease, and also the main cause of patient visits. Anemia can be caused by chronic blood loss, or by microvascular hemolysis.
Symptom
Symptoms of colorectal hemangioma Common symptoms Iron deficiency anemia, blood in the stool, urinary incontinence, intussusception, chronic anemia, hemolytic anemia
Blood in the stool and anemia
60% to 90% of patients with colorectal hemangioma seek medical treatment because of repeated massive painless blood in the stool. The blood color of the blood in the stool is bright red or purple-black, sometimes mixed with blood clots, and the bleeding is progressively aggravated. Most of them originate in young and young people, so patients Often accompanied by chronic anemia.
Hemorrhage caused by capillary hemangioma is often a slow and slow bleeding. Clinically, it is often characterized by chronic iron deficiency anemia. A small number of patients may have melena. The hemorrhage caused by cavernous hemangioma is often large, one time is more serious than once. It starts more often in childhood and has frequent bleeding.
2. Intestinal obstruction and intussusception
In patients with polypoid colonic hemangioma, in addition to lower gastrointestinal bleeding, it can also cause intestinal obstruction. In the literature, about 77% of patients with polypoid colonic hemangioma have a history of intestinal obstruction caused by intussusception, and some patients may also have intestinal torsion. .
3. Rectal irritation
Low rectal hemangioma is sometimes heavy and heavy, and the bowel movement is not clean.
4. Coagulation mechanism disorder
Another characteristic feature of extensive diffuse colorectal hemangioma is systemic coagulopathy, which exacerbates intestinal bleeding, some of which are associated with significant thrombocytopenia, hypofibrinogenemia, and blood clotting factor V. The decrease in the level of VIII and the like, on the one hand, is related to the increased destruction of peripheral blood coagulation factors, and on the other hand, it is related to the increase in the consumption of platelets and blood coagulation factors by hemangiomas. This consumptive coagulation disorder is often accompanied by Abnormal increase in fibrinogen degradation, accompanied by microvascular hemolytic anemia, all of the above-mentioned coagulation mechanism disorders can return to normal after resection of colorectal hemangioma.
5. Signs
Rectal anus examination showed a round or flat bulge mass in the rectum, the local mucosa was purple-red, the surface was smooth, some patients with mucosal congestion were red, easy to hemorrhage, rectal anus can be touched soft lumps, fingers A lightly compressed mass can be reduced, and there is no clear boundary for diffuse hemangioma.
It is worth noting that about 80% of patients with colorectal hemangioma are misdiagnosed as guinea or external hemorrhoids and undergo sputum surgery. Careful medical history can be found that almost all patients have a history of blood in the stool before the age of 10, usually at 10 There are many guilty people before the age of one.
The clinical manifestations of colorectal hemangioma vary with the type, size and location of the hemangioma. There is a history of hemangiomas in the family, mucosal and skin-like lesions, and signs of blood in the stool, anemia, and intestinal obstruction. For children or young patients with the above performance, the possibility of colorectal hemangioma, fiber endoscopy, lower gastrointestinal angiography and mesenteric artery angiography should be considered, which can provide diagnostic basis and lesion location.
Examine
Examination of colorectal hemangioma
Blood routine
There may be anemia manifestations such as red blood cell reduction and hemoglobin reduction; when there is extensive thrombosis in the hemangioma, platelets may be reduced due to large consumption.
2. Coagulation function check
There may be a decrease in fibrinogen and a decrease in coagulation factors V and VIII.
3. Regular inspection
The feces can be mixed with blood clots, or the blood in the stool is bright red or purple-black.
4. Fiber colonoscopy
Fibrocolonoscopy is an effective means of diagnosing colorectal hemangioma. It can determine the location, nature and extent of the lesion. Patients with suspected disease should be routinely examined, carefully examined for the location, extent, and presence of satellites. Lesions, etc.
The typical endoscopic appearance of colorectal hemangioma is a nodular mass in the intestinal mucosa that protrudes into the intestinal lumen. The lesions can be of different colors, ranging from cherry red to black, and the lesions vary in size. The mass can be polypoid or flat. Shape, when the intestine is inflated or gently compressed, the mass can be reduced. In the lesion, the dilated vein is often seen. A few can be seen as erosion or ulcer. Some lesions are diffusely distributed. The boundary of the lesion is difficult to determine. Very few patients have larger lesions. It can narrow the lumen of the intestine. In patients with lower gastrointestinal bleeding in the near future, mucosal damage or inflammation can be seen on or around the surface of the lesion.
Although the diagnosis can be confirmed by biopsy, it should be avoided as much as possible because it can cause uncontrolled bleeding.
5. Abdominal X-ray film
About 50% of patients with colonic hemangioma can find clustered calcified venous calculi in the lesion at the time of abdominal X-ray examination.
6. Colonic gas sputum double contrast
The performance of colonic hemangioma in the double contrast angiography of the colon is closely related to the type of hemangioma. In patients with venous dilatation, the colonic mucosa is dilated, showing a reticular or nodular bulge, and the margin is due to the dentate contour of the hemangioma. Typical scallop-like manifestations, in patients with polypoid hemangioma, can be seen in the intestine cavity mass and filling defects in the intestinal wall, in patients with severe diffuse hemangioma, the intestinal lumen of the diseased intestinal segment is uniform and narrow.
7. Arteriography
Selective mesenteric angiography can be further diagnosed on the basis of colonic endoscopy, abdominal X-ray film and colonic sputum. The typical angiographic findings are the expansion of clusters of blood vessels in the lesion, accompanied by hyperplasia. The dilated arteries and veins in the rectum and the rectum can be seen in patients with extensive lesions. The iliac vein can be accurately determined. The angiography can accurately determine the extent of the lesion of the hemangioma.
Diagnosis
Diagnosis and diagnosis of colorectal hemangioma
The diagnosis of this disease should be differentiated from internal hemorrhoids, external hemorrhoids, colorectal inflammatory disease, distal proctitis, solitary ulcer, rectal villous adenoma, rectal polyps and anorectal prolapse.
