Vascular Malformation of the Colorectum in Children: Case Series of 27 Patients
Chunhui Peng1, Sarah Siyin Tan1, Wenbo Pang1
1Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 of Nanlishi Road, Xicheng, Beijing, 100045, China.
Insights
Transanal endorectal pull-through (TEPT) is effective for treating pediatric colorectal vascular malformations. TEPT without laparotomy is a suitable option for shorter lesions, reducing operative time and bowel resection length.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Vascular Anomalies
Background:
- Colorectal vascular malformations are rare, primarily affecting children.
- Traditional treatments often necessitate laparotomy.
- Transanal endorectal pull-through (TEPT) has emerged as an alternative surgical approach.
Purpose of the Study:
- To characterize pediatric colorectal vascular malformations.
- To evaluate the outcomes of TEPT with or without laparotomy.
- To compare the efficacy of TEPT with and without laparotomy.
Main Methods:
- Retrospective analysis of patients undergoing TEPT (January 2010-December 2019).
- Data collection included clinical presentation, surgical approach, and follow-up parameters.
- Bowel function assessed using the Rintala score.
Main Results:
- Twenty-seven pediatric patients were analyzed; hematochezia and anemia were common.
- TEPT without laparotomy showed significantly shorter resection length and operative time compared to TEPT with laparotomy.
- Postoperative complications were low (11.1%), and bowel function outcomes were favorable.
Conclusions:
- Hematochezia, anemia, and hemorrhoid-like symptoms suggest colorectal vascular malformations in children.
- TEPT is an effective treatment for these conditions.
- TEPT without laparotomy is advantageous for shorter lesions, offering improved efficiency.
Background:
Vascular malformation of the colorectum is a rare disease that presents most commonly in early childhood. Some pull-through procedures have been performed for its treatment. However, laparotomy was routinely required. The aim of this study was to present features of this disease, as well as the outcomes of transanal endorectal pull-through (TEPT) with or without laparotomy.
Methods:
A retrospective analysis was performed on consecutive patients with vascular malformation of the colorectum who underwent TEPT with or without laparotomy in our hospital between January 2010 and December 2019. Follow-up information included hematochezia, other bleeding and bowel function. Bowel function was assessed using the Rintala score.
Results:
Twenty-seven patients were included (14 boys and 13 girls). Hematochezia and anemia were the main chief complaints. Perianal vasodilatation and prolapse of rectal mucosa with spurting blood were detected in 13 (48.1%) and 9 (33.3%), respectively. Eighteen patients (66.7%) underwent TEPT with laparotomy, and 9 patients underwent TEPT without laparotomy (including 5 TEPT under laparoscopic supervision) for lesions located beyond the distal sigmoid colon. Compared to TEPT with laparotomy, the length of resected bowel and operative time was significantly shorter in TEPT without laparotomy (p = 0.001 and p = 0.004). There was no statistical difference for intraoperative blood loss. Other vascular malformations were detected in 9 patients (33.3%); 3 were detected by laparoscopy. Three patients (11.1%) experienced postoperative complications. Follow-up was held with 24 patients (3 were lost to follow-up). The mean follow-up time was 51.9 ± 32.8 months. Four patients occasionally had bloody stools, without anemia. None had hematuria or vaginal bleeding. Median bowel function score was 20 (range 17-20).
Conclusion:
Hematochezia, anemia and hemorrhoid-like manifestations might be an indication for vascular malformation of the colorectum in children. TEPT was effective for vascular malformation of the colorectum, and TEPT without laparotomy was more suitable for the short lesions.
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