rectal arteriovenous malformation: a report of two cases, review of literature, and management algorithm

Background: diffuse cavernous hemangioma of the rectum (dchr) is very rare. despite the many diagnostic modalities available, achieving a correct diagnosis is difficult. management of these cases has evolved over the years; still, it poses a challenge because of the nature of the disease and extent of involvement. herein we present two cases of rectal arteriovenous malformation (avm) managed surgically. we also review the literature and propose a management algorithm for rectal avm. case presentation: two young patients presented with recurrent intermittent bleeding per rectum. one of them was misdiagnosed with a rectal polyp and underwent polypectomy without success elsewhere prior to referral to our hospital. the other patient presented with a history of recurrent bleeding since childhood. patients were evaluated with colonoscopy, contrast-enhanced computed tomography, and magnetic resonance imaging as diagnostic tools and also for localization. dchr was noted in both patients, extending from the dentate line up to the rectosigmoid in one patient and to the mid-sigmoid colon in the other. after preparation, both of them were taken up for surgery. ultra-low anterior resection with stapled coloanal anastomosis was performed in both. one of them had an uneventful postoperative recovery; the other developed a presacral abscess with spontaneous per rectal drainage. conclusion: dchr can be successfully managed surgically without sacrificing the anal canal, avoiding a permanent stoma. a management algorithm was proposed.