Deepa Budh, MD1, Daniel A. Casas, DO2, Coppola Domenico, MD3, Bhavtosh Dedania, MD4 1SBH Health System, Bronx, NY; 2HCA Healthcare / USF Morsani College of Medicine, Brandon Regional, Riverview, FL; 3Florida Digestive Health Specialists, Lakewood Ranch, FL; 4Florida Digestive Health Specialists, Brandon, FL
Introduction: Colonic hemangiomas are rare and presentation varies from vague abdominal pain, with or without haematochezia but rarely disguised as a colonic polyp. We present a rare case of cavernous colonic hemangioma (CCH) in the setting of severe diverticular disease.
Case Description/Methods: A 64-year-old man with a history of CAD s/p PCI, lymphoma in remission, heavy smoking came to the GI clinic with complaints of rectal bleeding, intermittent constipation, and a short-lived episode of abdominal pain 3 days prior. Examination and vitals were unremarkable with Hb of 11.9 gm/dl. Colonoscopy showed a large semi-pedunculated polypoidal mass in the sigmoid colon approximately measuring 30mm (Figure 1). Surrounding mucosa showed severe diverticulosis with peri-diverticular erythema. The mass appeared friable, erythematous with frond-like features suspicious for a slightly unusual appearance for a typical adenomatous polyp. Due to its semi-pedunculated nature, the polypoidal mass was able to be removed using a hot snare followed by a hemostatic clip. Pathology revealed complex anastomosing irregular branching vessels with thick and thin walls involving mucosa and submucosa. Special stains highlighted thick smooth muscle walls in vessels confirming the diagnosis of CCH (Figure 2). Post-procedure oral antibiotics, high fiber & standard laxatives were given with near-complete resolution of his symptoms which largely resolved due to endoscopic debulking of hemangioma causing obstructive symptoms and bleeding.
Discussion: Cavernous Hemangiomas are large thin-walled vascular channels without capsules. CCH can involve any location throughout the GI tract however studies support some association in the setting of chronic irritation and inflammation i.e. diverticulosis. CCH arises from the submucosal vascular plexus and could be sessile, pedunculated, mass-like, or mixed. Presentation range from asymptomatic to abdominal pain, anemia, rectal bleeding, and obstructive symptoms when large. Modalities like barium enema show nonspecific polypoidal or multi-lobular masses which collapse on-air insufflation, mesenteric angiography reveals hypervascularity and delayed venous pooling, CT scans specifically 3D CT colonography can help for better characterization and distribution of lesions but colonoscopy with biopsy is the gold standard. There are no standard guidelines for management but endoscopic resection or sometimes sclerotherapy may help but the most definitive management would be surgical resection.
Figure: Figures 1 and 2
Disclosures: Deepa Budh indicated no relevant financial relationships. Daniel Casas indicated no relevant financial relationships. Coppola Domenico indicated no relevant financial relationships. Bhavtosh Dedania indicated no relevant financial relationships.
Deepa Budh, MD1, Daniel A. Casas, DO2, Coppola Domenico, MD3, Bhavtosh Dedania, MD4. P1223 - Colonic Hemangioma Masquerading as Colonic Mass – Endoscopic Dilemma to Resect or Not?, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
