Related Experiment Videos
Vascular malformations of the colon in children
Luis de la Torre1, Daniel Carrasco, Ma Antonieta Mora
1Clinic of Colon and Rectum and the Departments of Surgery, Pathology, Radiology, and Gastroenterology, Instituto Nacional de Pediatría, Mexico City, Mexico.
Insights
Vascular malformations of the colon (VMC) in children often cause delayed diagnosis of lower intestinal bleeding (LIB). Early mesenteric arteriography is recommended for timely VMC detection and treatment.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Diagnostic Imaging
Background:
- Vascular malformations of the colon (VMC) are rare but significant causes of lower intestinal bleeding (LIB) in children.
- Diagnosis can be challenging, often leading to delayed identification and prolonged bleeding episodes.
Purpose of the Study:
- To comprehensively evaluate the clinical, radiologic, surgical, and histopathologic features of pediatric VMC.
- To assess the diagnostic utility of various imaging modalities and the outcomes of surgical interventions.
Main Methods:
- Retrospective analysis of 18 pediatric patients diagnosed with VMC and LIB.
- Review of clinical data, lower intestinal bleeding history, hemoglobin levels, and diagnostic imaging (scintigraphy, colonoscopy, barium enema, mesenteric arteriography).
- Evaluation of surgical procedures, histopathologic findings, and postoperative outcomes.
Main Results:
- Patients presented with LIB ranging from 1 week to 16 years of age, with bleeding durations of up to 9 years.
- Mesenteric arteriography successfully identified VMC in all 18 cases; left hemicolon and rectum were most commonly affected (83%).
- Surgical resection was performed in 14 patients, with 10 achieving good outcomes; rectal VMC posed surgical challenges. Histopathology confirmed arteriovenous VMC in 12 and arteriovenous-lymphatic VMC in 3 cases.
Conclusions:
- Delayed diagnosis of VMC in children with LIB is common.
- Early mesenteric arteriography is crucial for prompt VMC diagnosis.
- Surgical management of rectal VMC requires specialized approaches; a simplified classification is proposed.
Purpose:
The aim of this study was to evaluate clinical, radiologic, surgical, and histopathologic characteristics of vascular malformations of the colon (VMC) in children.
Methods:
Eighteen patients with lower intestinal bleeding (LIB) and VMC were included. Clinical data, angiographic features, surgical treatments, and histopathologic findings were analyzed.
Results:
Age of clinical onset was from 1 week to 16 years. Duration of LIB before diagnosis was from 1 month to 9 years. Admission hemoglobin level was 2 to 9 g/dL in 13 patients and in the other 5 was normal. Scintigraphy, colonoscopy, and barium enema results were normal or suggested a vascular problem. Mesenteric arteriography detected VMC in all 18 cases. Left hemicolon and rectum were affected in 83% of the cases. VMC were resected in 14 patients, 10 were anastomosed or pulled-through, and the other 4 required an intestinal stoma. Ten patients are asymptomatic, and 4 have minimal postoperative bleeding. The histopathologic study made in 15 cases (14 surgical specimens and 1 endoscopic biopsy), revealed arterial-venous VMC in 12 and arterial-venous-lymphatic VMC in 3 cases.
Conclusions:
The identification of VMC in children with LIB often is delayed. An early mesenteric arteriography should be added to the routine evaluation. Surgical treatment presents a challenge in rectal cases. To avoid confusion in the nomenclature a simplified morphologic classification is suggested.