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Spontaneous colonic perforation of a cavernous hemangioma during colonoscopy
Perforación colónica espontánea de un hemangioma cavernoso durante una colonoscopía
María Florencia Álvareza,
Corresponding author
florencia.alvarez88@gmail.com

Corresponding author.
, Domingo Cesar Balderramoa, Florencia Defantib, Mariano Antonio Higaa
a Gastroenterology Department, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
b Pathology Department, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cavernous hemangiomas of the colon &#40;CHC&#41; are very infrequent benign vascular lesions that commonly affect the rectosigmoid junction&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> CHC was described in 1839 and the pathogenesis associated with these lesions is not fully understood&#46; One possible explanation is that CHC derives from defects related to growth factors and endothelial cells of the mesodermal tissue&#46; About 80&#37; of extensive CHC are located in the rectum and sigmoid colon&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Clinical manifestations associated with CHC range from recurrent painless rectal bleeding to massive hemorrhage causing life threatening hemodynamic instability&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Spontaneous perforations during colonoscopy have not been described as a complication of CHC&#46; We describe a case of spontaneous colonic perforation of CHC during a diagnostic colonoscopy&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 76-year-old white man consulted for hypogastric pain and recent change in bowel movements&#46; Diagnostic colonoscopy was performed using insufflation with carbon dioxide&#46; During the procedure&#44; blood clots were observed in the right colon&#46; Upon arrival to the cecum&#44; an irregular&#44; ulcerated&#44; friable lesion with spontaneous bleeding was observed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; No hyperinflation was carried out&#46; No biopsies were performed and the procedure was immediately suspended because abdominal distension was observed&#44; with abnormal abdominal exploration&#46; The patient presented hemodynamic stability during the procedure&#46; Laboratory test were within normal limits&#46; Abdominal CT was performed showing pneumoperitoneum and abnormal thickening of the cecum fundus without regional lymph nodes &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Right colectomy with ileotransverse anastomosis was performed and the patient was discharged after 12 days of uncomplicated hospitalization&#46; Pathology final diagnosis showed ulcerated CHC located in the cecum with transmural perforation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; The patient presented an uncomplicated follow-up 6 months after surgery&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">We report on a case of spontaneous perforation of CHC during a diagnostic colonoscopy&#46; To the best of our knowledge&#44; this is the first case report of this complication in patients with CHC&#46; These lesions usually are located in rectum and sigmoid colon&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Few publications had described complications related to CHC&#44; being bleeding the most frequent&#46; In our report&#44; the patient complained of abdominal pain and change in bowel movements&#44; both clinical manifestations of CHC have not been described previously in these patients&#44; although these two clinical manifestations are unspecific&#46; Involvement of ileocecal valve with partial obstruction is frequently present in patients with inflammatory bowel disease and could explain manifestations such as bowel movements modification and abdominal pain&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Perforation during diagnostic colonoscopy is a very rare complication&#46; The rate of perforation in diagnostic colonoscopy ranges from 0&#46;022&#37; to 0&#46;268&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> The most frequent factors involved in cases of perforation of the cecum are the use of thermal energy or polypectomy&#46; Spontaneous cecal perforation during diagnostic colonoscopy is an infrequent complication&#46; Usually&#44; this complication is related to the presence of abnormal findings in the cecum as neoplasm or severe colitis&#44; due to the friability of the intestinal wall and insufflation&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">There are very scarce descriptions about clinical outcomes after severe complications associated with CHC&#46; Some of them mentioned severe blending with high requirement of transfusion and need of surgery&#46; In the present case surgical resolution was uncomplicated during follow up&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion&#44; we described an unfrequented localization of CHC with spontaneous cecal perforation during diagnostic colonoscopy&#46; Similar descriptions are needed to fully describe clinical presentations of CHC&#44; and the possibility of being a risk factor for complications when performing colonoscopy&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors&#8217; contribution</span><p id="par0035" class="elsevierStylePara elsevierViewall">Mar&#237;a Florencia &#193;lvarez and Domingo Cesar Balderramo wrote the manuscript&#46; All authors approved the submitted version&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">The present manuscript was performed without any financial support or grant&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">None of the authors have any potential conflicts &#40;financial&#44; professional&#44; or personal&#41; to disclosure&#46;</p></span></span>"
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Article information
ISSN: 02105705
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos