Diagnostics and surgical treatment strategy for rectal cavernous hemangiomas based on three case examples

A 20-year-old man with a congenital vascular malformation extending from th e anal canal into the distal sigmoid had had recurrent perianal blood loss as a neonate. A hemangioma was diagnosed for the first time in 1978. The pa tient received regular and frequent gastroenterological treatment until adm ission. Decisive for the indication for surgery was the patient's need for blood infusions and shorter bleeding intervals in June 1998. Surgical thera py consisted of deep anterior rectosigmoid resection with coloanal pouch an astomosis. In a second case of a 27-year-old woman a sigmoid hemangioma was diagnosed in conjunction with emergency sigmoid resectioning. Because of r ecurrent hemorrhages a coloanal pouch was also established here in a second step. The third case involved a 19-year-old woman with a 12-year history o f repeated perianal hemorrhages. After sigmoid discontinuity resection we c arried out proc tectomy with descendostoma creation due to renewed severe i ntractable perianal bleeding. The histological examination revealed a recta l hemangioma that had caused the repeated perianal hemorrhages. Surgical re construction was then achieved by coloanal pouch anastomosis. In view of th e good functional and perioperative results, current surgical therapy shoul d aim at preserving continuity and continence by coloanal pouch anastomosis .