Document Type
Poster
Publication Date
4-18-2024
Abstract
Case Report:
Hematochezia and anemia are common problems seen in the pediatric population, and oftentimes are managed on an outpatient basis. Lower GI bleeds are less common in children compared to upper GI bleeds, with vascular malformations being an uncommon cause of GI bleeds. While there have been published cases of pediatric colorectal vascular abnormalities, there have been few published cases of pelvic vascular anomalies that only cause colonic displacement without abnormality on colonoscopy.
We present the case of a 6 year-old male with a one-year history of hematochezia, constipation, and microcytic anemia initially managed outpatient with iron supplements and stool softeners. He was admitted to the hospital with severe anemia with a hemoglobin of 3.3g/dL requiring multiple transfusions. Family noted he had a protruding anal mass. Digital rectal exam demonstrated a firm, mobile, non-circumferential anal mass measuring 4 cm in diameter, and located predominantly at the right-anterior bowel wall.
Initial imaging including abdominal radiograph and abdominal ultrasound were negative. Colonoscopy was visually and histologically negative. MRI of the pelvis showed an extensive pelvic venous-lymphatic malformation in the left hemipelvis, with extension to the right hemipelvis, displacement of the rectum and distal sigmoid colon, and protrusion of the lesion into the anal region. Given the diffuse involvement of the lesion by time of presentation, the patient was not a candidate for surgery or sclerotherapy, and instead was started on Sirolimus.
Conclusion:
Pelvic vascular malformations, while rare and an uncommon cause of GI bleeds, should be on the differential diagnosis for the work-up of pediatric GI bleeds and anal masses in order to promote earlier identification and initiation of therapy. Providers should also be mindful of how socioeconomic barriers resulting in delay in care and complex diagnoses can affect management and potential prognosis.
Recommended Citation
Ordas, Kathleen; Joy-Marie Brusenback; Sahana Ummadi; Shannon Tocchio; Razan Alkhouri; and Soha Shah. "Hematochezia: An Abnormal Presentation of a Vascular Malformation." (2024). https://digitalrepository.unm.edu/hsc_2024_pediatric_research/12
