Embolization of a massive rectal hemangioma

Here’s an interesting case of a 46-year-old male with a massive rectal hemangioma that had been causing him refractory anemia and pain for several years.  Although he was counseled for several years to undergo proctectomy, he had previously refused, but now finally acquiesced. Preoperative arteriography and embolization was requested.

Axial and sagittal contrast enhanced CT images demonstrate marked mucosal thickening of the rectal wall circumferentially, with multiple phleboliths.

Axial T-1 weighted and post-gadolinium sagittal T-1 weighted images reveal markedly diffuse mucosal enhancement, and innumerable perirectal venous flow voids.

Arteriography of the superior rectal artery reveals no significant or arteriovenous shunting with only sparse small areas of early venous drainage.

Arteriography following embolization with Gelfoam (Pfizer, image A) and POD coils (Penumbra, Inc; image B).  Arterial flow is effectively arrested, and the surgeon reported minimal blood loss.

Case Credits

Images and content graciously provided by:

Jason E. Himmel, MD

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