Diffuse Cavernous Hemangioma of the Colon

A 70-year-old man was admitted to our clinic with a history of rectal bleeding and constipation, his colonoscopy revealed vari- cosities and bluish nodular lesions of the rectum (Figure 1). Abdominal CT showed multiple nodular lesions beginning from the distal descending colon and extending to the rectum, calcifi- cations suggesting phleboliths were also seen in these lesions. A contrast enhanced pelvic MRI demonstrated multiple tubular lesions showing hyperintensity on T2-weighted images and hypo- intensity on T1-weighted images, consistent with the affected areas on the CT scan (Figure 2). It was a diffuse cavernous hemangioma, which mostly affects the rectosigmoid colon in the gastrointestinal tract, and can clinically mimic internal hemorrhoids, ulcerative colitis or cancer (1). Gastrointestinal hemangioma is a rare benign vascular neoplasm, and might be associated with a congenital disorder like Osler-Weber-Rendu disease, Maffucci's syndrome, Klippel-Trénaunay syndrome, or the congenital blue rubber bleb nevus syndrome (2). Even though there are different medical treatment options targeting VEGF and FGF-mediated pathways such as bevacizumab and thalidomide, and endoscopic approa- ches like sclerotherapy and electrocautery; complete resection of the hemangioma is the only curative treatment method (1, 3). Therefore, the patient was referred to department of surgery for a definitive treatment, and lost to follow-up.