Rectal Arteriovenous Malformations: A case report of a rare cause of Lower Gastrointestinal Bleeding

TL;DR

This case report describes a rare rectal arteriovenous malformation causing persistent gastrointestinal bleeding and highlights the diagnostic and treatment challenges associated with this condition.

Contribution

The paper contributes a detailed case report and discussion on the management of rectal AVMs, emphasizing the lack of standardized guidelines.

Findings

Rectal AVMs are rare and often lead to significant clinical challenges due to limited diagnostic and treatment guidelines.

Surgical resection may be necessary when less invasive treatments like embolization fail.

Colonoscopy is a primary diagnostic tool, but definitive diagnosis often requires angiography.

Abstract

Rectal arteriovenous malformation (AVMs) are a rare cause of lower gastrointestinal bleeding. These vascular anomalies, typically present at birth, can progress over time and often lead to significant clinical challenges. The lack of a standardized classification or treatment guidelines further complicate diagnosis and management. This case report aims to contribute to the understanding of rectal AVMs by detailing clinical presentation, diagnosis, and treatment strategies.

We present a case of a 37-year-old male with hematuria and recurrent rectal bleeding, diagnosed through a series of imaging studies, including CT scan and pelvic MRI. Despite undergoing multiple angioembolization procedures, the patient's symptoms persisted, leading to significant anemia and frequent emergency interventions. The decision was made to proceed with a laparoscopic low anterior resection with diverting ileostomy after a thorough discussion of the risk and benefits.

This case underscore the complexity associated with diagnosis and managing rectal AVMs. The clinical presentation can vary significantly, and while symptoms often include painless rectal bleeding, many patients experience co-morbid condition due to chronic blood loss. Diagnosis typically involves imaging modalities, with angiography remaining the gold standard. Treatment options vary, and while angioembolization and endoscopic techniques may provide temporary relief, surgical intervention is often necessary for cases resistant to less invasive approaches.

Rectal AVMs represent a rare but significant cause of gastrointestinal bleeding, necessitating a high index of suspicion for diagnosis. This case highlights the challenges in management and the need for further research to establish standardized treatment protocols.

•Rectal arteriovenous malformations (AVMs) is a rare and underreported condition with limited literature and no standardized classification or management guidelines, leading to diagnostic challenges and variability in treatment approaches.•Rectal bleeding is the most common presenting symptom, with colonoscopy being the primary diagnostic tool.•Surgical resection, embolization and sclerotherapy are all available treatment modalities with variable success rate.

Rectal arteriovenous malformations (AVMs) is a rare and underreported condition with limited literature and no standardized classification or management guidelines, leading to diagnostic challenges and variability in treatment approaches.

Rectal bleeding is the most common presenting symptom, with colonoscopy being the primary diagnostic tool.

Surgical resection, embolization and sclerotherapy are all available treatment modalities with variable success rate.

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