ABSTRACT • Diffuse cavernous hemangioma of rectum (DCHR) is a rare entity, responsible of rectorragia generally in a young adult. A 19-year-old man presented for recurrent rectorragia treated for hemorrhoids without results.
The CT scan showed a non specific proctitis associated with perianal phleboliths. MRI showed concentric mural thickening with well demarcated high T2 signal contrasting with the normal wall. The diagnosis was established and surgery was decided after the failure of angio-embolization, that confirmed the DCHR. The DCHR could be localized or extended in the setting of diffuse hemangiomatosis sometimes as part of a syndrome (Rendu-Osler-Weber, Mafucci).

The most frequent type of rectal hemangiomas is the cavernous type. They lead to rectorragias that could threaten the prognosis and sometimes anal pain and rarely obstruction or perforation. Biopsy could lead to bleeding and is not advised. The diagnosis is endoscopic and radiological, based on CT scan and MRI. The CT scan shows mural thickening with sometimes enhancement showing temporal progression that is specific as are presacral phleboliths when present.These findings are relatively specific of the diagnosis together with the delineated high T2 signal and mural thickening on MRI. Both techniques can show abnormal vessels in and around the rectal wall. Surgery constitutes the main treatment nowadays.

Keywords: hemangioma; rectum; CT scan; MRI; hematochezia

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