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Case Reports
. 2020 Jan 20;14(1):7-14.
doi: 10.1159/000505090. eCollection 2020 Jan-Apr.

Rectal Arteriovenous Malformation Treated by Transcatheter Arterial Embolization

Sho Ishikawa  1 , Shoichiro Mukai  1 , Yuzo Hirata  1 , Akihiro Kohata  1 , Azusa Kai  1 , Yosuke Namba  1 , Sho Okimoto  1 , Seiji Fujisaki  1 , Saburo Fukuda  1 , Mamoru Takahashi  1 , Toshikatsu Fukuda  1 , Hideki Ohdan  2
Affiliations
Case Reports

Rectal Arteriovenous Malformation Treated by Transcatheter Arterial Embolization

Sho Ishikawa et al. Case Rep Gastroenterol. .

Abstract

An 86-year-old man who presented with frequent hematochezia with mild anemia on blood tests was admitted to our hospital. Colonoscopy exhibited a submucosal tumor-like lesion in the lower rectum. CT and MRI showed blood flow into the lesion, but not tumor component. Angiography of the superior rectal artery and left internal iliac artery showed vascular hyperplasia and nidus. Thus, rectal arteriovenous malformation was diagnosed. If bleeding from arteriovenous malformation was out of control, surgical resection was necessary. However, due to the age of the patient, we performed transcatheter arterial embolization and abdominoperineal resection was not needed. Embolization from the left superior rectal artery, middle rectal artery and inferior rectal artery was performed to control the bleeding and to avoid surgery. After embolization, he was followed up for 10 months in our hospital without recurrence.

Keywords: Arteriovenous malformation; Hematochezia; Interventional radiology; Transcatheter embolization.

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Conflict of interest statement

We declare no conflicts of interest associated with the manuscript.

Figures

Fig. 1
Fig. 1
a Colonoscopy revealed a submucosal tumor-like lesion in the lower rectum. b In the mucous membrane covering the tumor-like surface, meandering blood vessels were exposed. c Endoscopic ultrasonography revealed the lesion located outside of the rectum wall. d Color Doppler ultrasonography showed flow regions and it was considered to be a lesion rich in blood vessels.
Fig. 2
Fig. 2
a CECT revealed accumulation of abnormal vessels in the lower rectum. b 3D-reconstruction of the CECT showed that blood flow to the lesion was supplied from the superior rectal artery and the left middle or inferior rectal artery. c, d MRI showed low signal intensity in the thickened rectal wall on T1- and T2-weighted images (T1WI and T2WI), due to which edema of the rectal wall was suspected. T1WI (c) and T2WI (d) showed flow voids in the thickened rectal wall (arrow) suggesting vascular lesion.
Fig. 3
Fig. 3
a Angiography in the SRA. b Angiography in the left IIA. Pelvic angiography image showing nidus of the rectal AVM. The nidus (asterisk) was visualized by imaging of the SRA (arrow, a) and left MRA (arrow, b, upper) and IRA (arrow, b, under).
Fig. 4
Fig. 4
a Angiography in SRA before embolization. b Angiography in SRA after embolization. c Angiography in the left IIA before embolization. d Angiography in the left IIA after embolization. After embolization from the SRA, left MRA and IRA, angiography showed obliteration of the blood flow into the nidus (asterisk).
See this image and copyright information in PMC

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