INTESTINAL VASCULAR ANOMALIES IN CHILDREN

Vascular anomalies are an uncommon cause of gastrointestinal bleeding in childhood, Confusing nomenclature has made objective comparisons of published cases difficult and has interfered with an established cons ensus regarding diagnosis and therapeutic modalities, The purpose of t his study was to clarify the situation by reviewing the records of all children who had intestinal vascular anomalies who were referred to o ur institution from 1975 to 1995, Thirteen lesions were identified in nine children (five boys and four girls), The median age at clinical o nset was 8 years, Only two patients presented with a complex syndrome (Klippel-Trenaunay, 1; Osler-Rendu-Weber, 1). Diagnosis, location, and extension of these anomalies was only possible by angiography, which indicated that seven patients had isolated venous malformations and tw o had arteriovenous malformations, Because the lesions did not involve the serosa, intraoperative localization was a major problem. The main findings were a few slightly dilated mesenteric veins. Treatment was conservative in four children and surgical in five, Pathological findi ngs on resected bower demonstrated dilated and abnormal veins in the m ucosa and submucosa, Selective angiography should not be delayed in pa tients with gastrointestinal bleeding if results of all other investig ations are negative. Because these lesions are rarely recognizable on operative inspection, precise preoperative angiographic localization o f intestinal vascular anomalies is essential to allow for a safe and l imited resection of the involved bowel segment. Based on a better unde rstanding of the natural history of these lesions, a classification of vascular anomalies of intestines in children is proposed. Copyright ( C) 1997 by W.B. Saunders Company.