Vascular malformations of the colon in children.

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.