An Investigation of Clinical Features and Exploration of Comprehensive Treatments for Colorectal Vascular Malformation in Children

Abstract

Objectives: To summarize the clinical features, treatment methods, and outcomes of the rare diseases of colorectal vascular malformation (CRVM).Methods: We retrospectively analyzed clinical data of CRVM patients admitted to the Department of Pediatric Surgery of Children's Hospital of Fudan University from 2004 to 2019.Results: A total of 23 cases (16 males, 7 females) were enrolled. The median age of symptom onset was 1.4 years. Eleven patients had been misdiagnosed, and the average time from symptom onset to diagnosis was 4.5±4.4 years. Associated vascular malformations in the skin and other parts were found in eight patients. All patients showed a positive anomalous vascular image in the rectum and surrounding areas with contrast-enhanced computed tomography (CT) / magnetic resonance imaging (MRI). The sensitivity of endoscopy in the diagnosis of CRVM was 82.6%. A total of 21 patients underwent a modified Soave procedure. The lesions were mostly restricted to the rectum and sigmoid, with an average length of 20±5.4cm. The median follow-up time was 78 months. Bloody stools reappeared within 6 months in three patients, but were cured by sclerotherapy or fulguration. At the last time of follow-up, bloody stool symptoms were absent and hemoglobin was in the normal range for all patients.Conclusions: CRVM occurs more commonly in male children than in female children. Combined with enhanced MRI, CT, and colonoscopy, CRVM diagnosis can be confirmed. The lesioned intestinal segment can be safely removed through a modified transabdominal Soave procedure, effectively curing or relieving hematochezia.