A Rare Case of Transverse Colonic Cavernous Hemangioma: An Ambiguous Preoperative Diagnosis, An Inappropriate Biopsy, A Fortunate Outcome, One Good Lesson and Some Serious Reflections | Insight Medical Publishing

Background: Cavernous hemangioma of colon is an uncommon vascular malformation, usually presenting with painless rectal bleeding and anemia. Examinations of computerized tomography, magnetic resonance image and colonoscopy are helpful to establish a definitive diagnosis. But sometimes however, it is difficult to recognize this kind of tumor due to lack of specific findings. Surgical treatment is often the first choice. Other treatments like sclerotherapy, electrocautery, radium implantation or cryosurgery have also been described. Case presentation: We reported one case of cavernous hemangioma located in transverse colon treated by laparoscopic segmental colonic resection. The diagnosis we suspected before the operation was gastrointestinal stroma tumor. But the paraffin pathology proved it a hemangioma. Fortunately, protractor biopsy did not lead to hemorrhage and the hemangioma was resected successfully. Conclusion: Colonic hemangiomas are extremely rare in clinical practice. Some of them have untypical radiological and endoscopic manifestations, which make preoperative diagnosis ambiguous. Endoscopic biopsy should be cautious. Consultation with experienced radiologists, endoscopic physicians and multidisciplinary team is beneficial. Choice of the surgical method depends on intraoperative judgement and the result of frozen pathology. And paraffin pathology decides whether carry out an extended or radical colectomy afterwards.