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. Copyright 2002, Elsevier Science (USA). All rights reserved.