Recognition and treatment of venous malformations of the rectum

Venous malformations of the rectum are uncommon lesions that present complex management problems (1-6). The vast majority of these lesions present with rectal bleeding in infancy or childhood. Many cases have been treated as colitis for years before the correct diagnosis was made. The correct diagnosis has generally been based on gross appearance, confirmed subsequently by plain radiographs and angiography. Heroic surgical intervention has been the only repeatedly reported 'cure' in the literature. One patient has been reported who did well for 20 years with sclerosis of the hemorrhoidal vein at surgery followed by intermittent transrectal sclerotherapy (7.8). Another patient would appear to have had long-term success with radiation therapy (9-11). We report four new cases of venous malformations of the rectum and results to date of a new therapeutic option with transcutaneous ethanol sclerotherapy in two of these patients. A discussion of alternate methods of treatment is included.