title: Sphincter-saving resection of rectal hemangioma based on Doppler transrectal ultrasonography findings: report of a case.
abstract: A 52-year-old woman was diagnosed with rectal hemangioma that had resulted in chronic bleeding. Klippel-Trenaunay syndrome was diagnosed by clinical examination. She was referred 30 years later because of progressive anemia. Colonoscopy revealed multiple bluish, polypoid nodules with severe vascular congestion and varicosis that had circumferentially spread along the wall from the dentate line to the rectosigmoid lesion. Selective abdominal angiography indicated that the hemangioma fed from the sigmoid artery and superior rectal artery. Doppler transrectal ultrasonography showed heterogeneous lesions with hypoechoic areas mostly in the submucosal layer, partly forming the mosaic pattern of the color flow signal in the intersphincteric layer on the oral side from the dentate line to 1 cm. Anterior resection and coloanal anastomosis with covering ileostomy was performed. Using a transanal approach, mucosectomy and intersphincteric resection were performed based on the Doppler transrectal ultrasonography results. There were no intraoperative complications, and her anemia resolved postoperatively.
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Fujikawa
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Araki
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Okita
authors.forename: Koji
authors.initials: K
authors.lastname: Tanaka
authors.forename: Junichiro
authors.initials: J
authors.lastname: Hiro
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Inoue
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Mohri
authors.forename: Keiichi
authors.initials: K
authors.lastname: Uchida
authors.forename: Masato
authors.initials: M
authors.lastname: Kusunoki
mesh_terms: D000714:Anastomosis, Surgical; D000792:Angiography; D003113:Colonoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery; D006391:Hemangioma / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007081:Ileostomy; D007715:Klippel-Trenaunay-Weber Syndrome / Q000000981:diagnostic imaging* / Q000601:surgery*; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D018608:Ultrasonography, Doppler
keywords: Rectal hemangioma; Sphincter-saving resection; Transrectal ultrasonography