PDF(Pubmed)
Abstract：
UNASSIGNED: We present the case of a 17 years old girl with per rectal haemorrhage secondary to pelvic arteriovenous malformations (AVM) and potentially haemorrhoids. Pelvic AVMs are rare and extremely variable in their clinical presentation, size and location and pose a therapeutic challenge. Focus has turned towards interventional radiological procedures with angioembolisation as the main treatment form for pelvic AVMs.
METHODS: A 17 years old girl presented to a rural hospital with significant per rectal bleeding requiring transfer to a tertiary centre with interventional radiology capabilities. Diagnostic imaging determined the presence of a pelvic AVM as well as haemorrhoid. She had no prior history of haemorrhoids, per rectal bleeding or per vaginal bleeding. Further diagnostic imaging including a digital subtraction angiography and MRI pelvis was performed and her case was discussed at a multidisciplinary meeting where the decision was made for angioembolisation of a large right rectal AVM as well as precautionary banding of haemorrhoids that had developed secondary to outflow obstruction. A repeat CT mesenteric angiogram a month later demonstrated diminished appearances of the rectal AVM.
UNASSIGNED: Pelvic AVMs are a rare entity and are not a common cause for per rectal bleeding. There is currently no direct consensus on the optimum management of complex pelvic AVMs particularly those that present with a second pathology such as haemorrhoids. Surgical management often results in recurrence or rapid progression of the AVM lesion and recruitment of new blood supply further complicates the problem. Selective embolisation allows for control of haemorrhage and utilises chemical agents as well as detachable coils and balloons. However, postoperative pain and swelling can still be expected and multiple transcatheter embolisations may be required.
CONCLUSIONS: The treatment of symptomatic pelvic AVMs is complex and requires a multidisciplinary approach with careful radiological planning prior to embolisation. Angioembolisation is becoming increasingly prevalent and multiple embolisation procedures may be required to reach the desired therapeutic effect.
METHODS: A 17 years old girl presented to a rural hospital with significant per rectal bleeding requiring transfer to a tertiary centre with interventional radiology capabilities. Diagnostic imaging determined the presence of a pelvic AVM as well as haemorrhoid. She had no prior history of haemorrhoids, per rectal bleeding or per vaginal bleeding. Further diagnostic imaging including a digital subtraction angiography and MRI pelvis was performed and her case was discussed at a multidisciplinary meeting where the decision was made for angioembolisation of a large right rectal AVM as well as precautionary banding of haemorrhoids that had developed secondary to outflow obstruction. A repeat CT mesenteric angiogram a month later demonstrated diminished appearances of the rectal AVM.
UNASSIGNED: Pelvic AVMs are a rare entity and are not a common cause for per rectal bleeding. There is currently no direct consensus on the optimum management of complex pelvic AVMs particularly those that present with a second pathology such as haemorrhoids. Surgical management often results in recurrence or rapid progression of the AVM lesion and recruitment of new blood supply further complicates the problem. Selective embolisation allows for control of haemorrhage and utilises chemical agents as well as detachable coils and balloons. However, postoperative pain and swelling can still be expected and multiple transcatheter embolisations may be required.
CONCLUSIONS: The treatment of symptomatic pelvic AVMs is complex and requires a multidisciplinary approach with careful radiological planning prior to embolisation. Angioembolisation is becoming increasingly prevalent and multiple embolisation procedures may be required to reach the desired therapeutic effect.
摘要：
■我们介绍了一个17岁女孩的病例，其中直肠出血继发于盆腔动静脉畸形（AVM）和潜在的痔疮。盆腔动静脉畸形在临床表现上非常罕见且变化很大，大小和位置，并构成治疗挑战。研究重点已转向以血管栓塞术作为骨盆AVM的主要治疗形式的介入放射学程序。
方法：一名17岁女孩因直肠出血严重而被送往乡村医院，需要转移到具有介入放射学能力的三级中心。诊断成像确定了盆腔AVM以及痔疮的存在。她之前没有痔疮病史,每次直肠出血或每次阴道出血。进行了进一步的诊断成像，包括数字减影血管造影和MRI骨盆，并在多学科会议上讨论了她的病例，该会议决定对大型右直肠AVM进行血管栓塞以及对继发于流出道阻塞的痔疮进行预防性绑扎。一个月后重复CT肠系膜血管造影显示直肠AVM的出现减少。
■盆腔AVM是一种罕见的实体，不是直肠出血的常见原因。目前，对于复杂的盆腔AVM的最佳管理尚无直接共识，尤其是那些伴有第二种病理如痔疮的患者。手术处理通常导致AVM病变的复发或快速进展,并且新的血液供应的募集进一步使问题复杂化。选择性栓塞可以控制出血，并使用化学试剂以及可拆卸的线圈和球囊。然而,术后疼痛和肿胀仍可预期,可能需要多次经导管栓塞.
结论：有症状的盆腔AVM的治疗是复杂的，需要多学科的方法，并在栓塞前进行仔细的放射学规划。血管栓塞变得越来越普遍,并且可能需要多个栓塞程序以达到期望的治疗效果。
方法：一名17岁女孩因直肠出血严重而被送往乡村医院，需要转移到具有介入放射学能力的三级中心。诊断成像确定了盆腔AVM以及痔疮的存在。她之前没有痔疮病史,每次直肠出血或每次阴道出血。进行了进一步的诊断成像，包括数字减影血管造影和MRI骨盆，并在多学科会议上讨论了她的病例，该会议决定对大型右直肠AVM进行血管栓塞以及对继发于流出道阻塞的痔疮进行预防性绑扎。一个月后重复CT肠系膜血管造影显示直肠AVM的出现减少。
■盆腔AVM是一种罕见的实体，不是直肠出血的常见原因。目前，对于复杂的盆腔AVM的最佳管理尚无直接共识，尤其是那些伴有第二种病理如痔疮的患者。手术处理通常导致AVM病变的复发或快速进展,并且新的血液供应的募集进一步使问题复杂化。选择性栓塞可以控制出血，并使用化学试剂以及可拆卸的线圈和球囊。然而,术后疼痛和肿胀仍可预期,可能需要多次经导管栓塞.
结论：有症状的盆腔AVM的治疗是复杂的，需要多学科的方法，并在栓塞前进行仔细的放射学规划。血管栓塞变得越来越普遍,并且可能需要多个栓塞程序以达到期望的治疗效果。
