Saudi Journal of Gastroenterology
Home About us Instructions Submission Subscribe Advertise Contact Login    Print this page  Email this page Small font sizeDefault font sizeIncrease font size 
Users Online: 261 


 
Table of Contents   
IMAGE QUIZ  
Year : 2011  |  Volume : 17  |  Issue : 6  |  Page : 421-422
Unusual cause of rectal bleeding


Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India

Click here for correspondence address and email

Date of Web Publication5-Nov-2011
 

How to cite this article:
Garg PK, Kumar A. Unusual cause of rectal bleeding. Saudi J Gastroenterol 2011;17:421-2

How to cite this URL:
Garg PK, Kumar A. Unusual cause of rectal bleeding. Saudi J Gastroenterol [serial online] 2011 [cited 2022 Sep 27];17:421-2. Available from: https://www.saudijgastro.com/text.asp?2011/17/6/421/87187


A 19-year-old young man presented with multiple episodes of rectal bleeding of 2 years duration. On physical examination, he had severe pallor and an asymmetric, edematous hypertrophy of left lower limb with multiple dilated and tortuous veins present along the posterolateral aspect [Figure 1]. Laboratory evaluation demonstrated significant anemia with hemoglobin of 6.9 g/dL and hematocrit of 20.9%. Diagnostic colonoscopy demonstrated venous ectasia extending from the dentate line to descending colon [Figure 2]. No active bleeding was noted. Esophago-gastroduodenoscopy was unremarkable.
Figure 1: Clinical photograph showing asymmetric, edematous hypertrophy of left lower limb

Click here to view
Figure 2: Colonoscopy showing multiple venous ectasia in rectum

Click here to view



   Question Top


Q1. What is the diagnosis?


   Answer Top


The clinical picture is consistent with the diagnosis of Klippel-Trenaunay Syndrome (KTS). Noted French physicians Maurice Klippel and Paul Trenaunay described this syndrome in 1900 which is characterized by a triad of vascular malformations, venous varicosity and bony and/or soft tissue hypertrophy. [1] Visceral vascular malformations are uncommon in KTS but may cause significant morbidity and mortality. [2] Gastrointestinal malformations are more common than those of genitourinary tract. Bleeding is the most common manifestation of intestinal vascular malformations and may prove to be a potentially life-threatening emergency. Platelet sequestration with secondary consumption of clotting factors within the venous sinusoids of the visceral vascular malformations may further enhance bleeding (Kasabach-Merritt phenomenon). [3]

 
   References Top

1.Jacob AG, Driscoll DJ, Shaughnessy WJ, Stanson AW, Clay RP, Gloviczki P. Klippel-Trénaunay syndrome. Spectrum and management. Mayo Clin Proc 1998;73:28-36.  Back to cited text no. 1
    
2.Servelle M, Bastin R, Loygue J, Montagnani A, Bacour F, Soulie J, et al. Hematuria and rectal bleeding in the child with Klippel and Trénaunay syndrome. Ann Surg1976;183:418-28.  Back to cited text no. 2
    
3.Abass K, Saad H, Kherala M, Abd-Elsayed AA. Successful treatment of kasabach-merritt syndrome with vincristine and surgery: a case report and review of literature. Cases J 2008;1:9.  Back to cited text no. 3
    

Top
Correspondence Address:
Pankaj K Garg
Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi - 110 095
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-3767.87187

Rights and Permissions


    Figures

  [Figure 1], [Figure 2]



 

Top
  
 
  Search
 
  
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


   Question
   Answer
    References
    Article Figures

 Article Access Statistics
    Viewed2588    
    Printed117    
    Emailed0    
    PDF Downloaded420    
    Comments [Add]    

Recommend this journal