BACKGROUND: Anorectal hemangioma is a rare and frequently misdiagnosed cause of lower gastrointestinal (GI) bleeding. Here, we present a minimally invasive therapy with selective embolization. CASE SUMMARY: A 21-year-old male patient experienced painless rectal bleeding since childhood and was treated for ulcerative colitis. Diagnostic studies later revealed specific characteristics for vascular lesions-anorectal hemangiomas. The severity of rectal bleeding caused symptomatic anemia and possible surgical treatment was associated with a high risk of fecal incontinence. Here, we present selective embolization, a minimally invasive therapeutic approach that is proven as an alternative therapeutic method of choice. The patient significantly improved temporarily and had a small ischemic ulcer, which healed with a control colonoscopy and developed no stenosis. CONCLUSION: Awareness of the clinical and radiological features of GI hemangiomas may help improve diagnostics and avoid inappropriate therapeutic procedures.

Department of Internal Medicine Hospital in Frydek Mistek Frydek Mistek 73801 Czech Republic

Department of Radiodiagnostic Hospital in Jablonec nad Nisou Jablonec nad Nisou 46601 Czech Republic

Department of Radiology University Hospital Hradec Kralove Hradec Kralove 50005 Czech Republic

Department of Surgery Hospital Horovice Horovice 26831 Czech Republic

Faculty of Medicine University of Ostrava Ostrava 70300 Czech Republic

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Shen JD, Chen CW, Chen TA, Yueh T. Colonic hemangioma, a diagnostic challenge in young adults with lower gastrointestinal tract bleeding. Formosan J Surg. 2016;49:238–241.

Ganesananthan S, Barlow J, Durai D, Hawthorne AB. Multiple venous malformations in the left colon and rectum: a long-standing case managed conservatively and an update of current literature. BMJ Case Rep. 2019;12 PubMed PMC

Neto WBDS, Neto GT, Cunha CMQD, Brasil AC, Feitosa JNP. Anorectal hemangioma – differential diagnosis of anal bleeding. J Coloproctol. 2017;37:44–46.

Zeng Z, Wu X, Chen J, Luo S, Hou Y, Kang L. Safety and Feasibility of Transanal Endoscopic Surgery for Diffuse Cavernous Hemangioma of the Rectum. Gastroenterol Res Pract. 2019;2019:1732340. PubMed PMC

Yoo S. GI-Associated Hemangiomas and Vascular Malformations. Clin Colon Rectal Surg. 2011;24:193–200. PubMed PMC

Levy AD, Abbott RM, Rohrmann CA Jr, Frazier AA, Kende A. Gastrointestinal hemangiomas: imaging findings with pathologic correlation in pediatric and adult patients. AJR Am J Roentgenol. 2001;177:1073–1081. PubMed

Cotzias E, Rehman SF, Arsalani Zadeh R, Smith D. Conservative management of diffuse cavernous haemangioma of the sigmoid and rectum. Ann R Coll Surg Engl. 2020;102:e1–e3. PubMed PMC

Al-Tkrit A, Aneeb M, Mekaiel A, Alawawdeh F, Mehta A. Cavernous Hemangioma: A Rare Cause of Massive Lower Gastrointestinal Bleeding. Cureus. 2020;12:e10075. PubMed PMC

Hermosa AR, Zorrilla-Ortuzar J, Valle-Hernández ED. Diffuse cavernous hemangioma of the rectum. Cir Cir. 2021;89:818–821. PubMed

Wassef M, Blei F, Adams D, Alomari A, Baselga E, Berenstein A, Burrows P, Frieden IJ, Garzon MC, Lopez-Gutierrez JC, Lord DJ, Mitchel S, Powell J, Prendiville J, Vikkula M ISSVA Board and Scientific Committee. Vascular Anomalies Classification: Recommendations From the International Society for the Study of Vascular Anomalies. Pediatrics. 2015;136:e203–e214. PubMed

Mascarenhas M, Morais R, Teixeira R, Macedo G. A case report of an unexpected colonic polyp: cavernous hemangioma. Ann Coloproctol. 2023;39:280–282. PubMed PMC

Sheth RA, Sabir S, Krishnamurthy S, Avery RK, Zhang YS, Khademhosseini A, Oklu R. Endovascular Embolization by Transcatheter Delivery of Particles: Past, Present, and Future. J Funct Biomater. 2017;8 PubMed PMC