Abstracts
1998 Digestive Disease Week

#1010

TOWARDS A BETTER DEFINITION OF HEMANGIOMAS OF THE RECTUM. JM Sarmiento, S. Nivatvongs, S. Zaheer. Mayo Clinic, Rochester, MN.

Introduction: Hemangiomas of the rectum (HR) is an uncommon condition, since no large series have been reported. Their clinical features are not well defined.

Methods: We reviewed the experience on HR at Mayo Clinic from 1967 to 1995. Information was retrieved from endoscopic data, pathology reports, and registry archives. Only patients with histologic diagnosis of the disease were included, in whom follow-up was at least 2 years. HR were classified according to the lesion size. Median follow-up time was calculated using Kaplan-Meier analysis. Differences between groups were analyzed by Wilcoxon test. Results: Twelve patients fulfilled the inclusion criteria. From these, 7 were classified as small (generally less than 2 cm), and 5 as large (invariably larger than 5 cm), which corresponded to capillary and diffuse cavernous hemangiomas, respectively. Large HR were present in younger population (mean ± SD, 21 ± 6 vs. 58 ± 11 years, p < 0.05). They consistently had rectal bleeding, in contrast to small HR in which this was not a prominent feature (1 out of 7). Small HR were not associated with vascular diseases or dermal hemangiomas, as were the large types (Klippel-Trenaunay-Weber Syndrome in one case). Seven patients with small HR underwent endoscopic excision and electrocoagulation, without recurrence of the lesion. In patients with large HR, 2 underwent resective procedures (Low Anterior Resection and Abdominoperineal Resection), with no recurrence; one patient underwent per anal excision which led to persistent bleeding; and the remaining 2 refused surgery. In every case of the latter type, preoperative severe bleeding with multiple transfusions were typical. Median follow-up time was 4 years.

Conclusions: This is the largest series reported on HR. Diffuse cavernous HR require an aggressive surgical approach, given the nature of the disease, and can have a congenital etiology. Capillary HR might be part of the spectrum of acquired vascular malformations of the rectum, and usually follow a benign course.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.