CASE REPORT Laparoscopic-assisted bowel resection with construction of a colonic reservoir for cavernous hemangioma of the rectum: report of two cases R. F. Leal • M. de Lourdes Setsuko Ayrizono • P. V. Villalobos Tapia Silva • P. de Sene Portel Oliveira • J. J. Fagundes • C. S. Rodrigues Coy Received: 22 August 2010 / Accepted: 15 March 2011 / Published online: 20 April 2011 Ó Springer-Verlag 2011 Abstract Diffuse cavernous hemangioma of the rectum is an unusual benign vascular lesion, marked by delayed diagnosis and often presenting recurrent rectal bleeding and anemia. Colorectal resection with coloanal anastomo- sis and construction of a colonic reservoir is the preferred surgical treatment. We report two cases of patients, a 23-year-old man and a 27-year-old woman, with cavernous hemangioma of the rectum, diagnosed by colonoscopy and confirmed by magnetic resonance imaging. Arteriography demonstrated vascular tumors in the rectal wall. Use of the embolization technique was not successful, since no large caliber vessel was available for this procedure. The patients underwent anterior abdominal excision of the rectum with a laparoscopic approach? colonic reservoir and hand sewn coloanal anastomosis. Ileostomy closure was performed in both patients at 3 months after surgery, and they demon- strated good early and late postoperative outcomes. In summary, laparoscopic-assisted bowel resection may be a good option for surgical management of diffuse cavernous hemangioma of the rectum. Keywords Cavernous hemangioma Á Laparoscopic approach Á Colonic reservoir Á Coloanal anastomosis Á Colorectal resection Á Rectal disease Introduction Cavernous hemangioma of the rectum is a rare condition, and the rectosigmoid colon is the most common site of this benign vascular lesion in the gastrointestinal tract. It most commonly affects young patients, and the main presenta- tion is episodic and painless rectal bleeding. Due to its characteristics, diagnosis often is delayed and seldom made until the third decade [1–3]. Examinations used for diag- nosis include colonoscopy, computed tomography (CT), magnetic resonance imaging (MRI), and selective angiog- raphy. Computed tomography and MRI allow the surgeon to identify the dimensions of the tumor and the possible involvement of other structures [4, 5]. Complete surgical resection with a sphincter-saving procedure is the best therapeutic option if angiographic embolization is not feasible [6, 7]. Major laparoscopic bowel surgery has been performed during recent years in the most important centers; however, there are few reports of the use of this technique to treat cavernous hemangioma of the rectum [8]. Case reports A 23-year-old male patient (case 1) presented at our Col- oproctology Outpatient Clinic, reporting episodic rectal bleeding and anemia for 8 years. A progressive worsening of the symptoms had been observed during the last 3 years, and hemoglobin levels had reached 4.4 g/dl. Pain was not present and no alteration in bowel habits was reported. The patient had no history of colorectal disease. Upon digital rectal examination, there was no mass, but blood was observed on the glove. Colonoscopy was performed and multiple rectal bluish varicosities, extending 12 cm up from the pectinate line, were identified. The patient underwent R. F. Leal (&) Á M. de Lourdes Setsuko Ayrizono Á P. V. Villalobos Tapia Silva Á P. de Sene Portel Oliveira Á J. J. Fagundes Á C. S. Rodrigues Coy Coloproctology Unit, Department of Surgery, University of Campinas, UNICAMP, Rua Patativa, no 170, apto 24C, Bonfim, Campinas, Sao Paulo 13034-810, Brazil e-mail: raquelleal@mpc.com.br; ccoy@terra.com.br 123 Tech Coloproctol (2011) 15:205–207 DOI 10.1007/s10151-011-0685-5