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A 57 Age - year Age - old Age male Sex was admitted Clinical_event to our hospital Nonbiological_location with 5 Duration months Duration ’ history History of History massive History rectal Biological_structure bleeding History (rectorrhagia) History .
He had past History history History of History passage History of History fresh History blood History mixed History stool History since History last Duration 55 Duration years Duration .
He first complained of rectal Biological_structure bleeding History at History the History age Date of Date 2 Date .
He went Clinical_event hospital Nonbiological_location numerous times for this symptom Coreference ; multiple interventions Therapeutic_procedure were done but disease was not cured completely.
During one of his hospital visit in the past (patient forgot the date), he was diagnosed History and History treated History as History hemorrhoids History .
The symptom Sign_symptom was relieved for a Duration while Duration and then recurred Sign_symptom again.
Thirty Date years Date ago Date , he was diagnosed as rectal Biological_structure hemangioma Disease_disorder and managed with cryotherapy Therapeutic_procedure in our hospital Nonbiological_location .
That could also just relieve the symptom Sign_symptom for few Duration years Duration and it recurred Sign_symptom again.
Then, he consulted Clinical_event many Nonbiological_location other Nonbiological_location hospitals Nonbiological_location , but could only get short Detailed_description - term Detailed_description symptomatic Sign_symptom relief Sign_symptom without proper treatment of the cause.
Since Duration 5 Duration months Duration , the severity of rectal Biological_structure bleeding Sign_symptom increased.
He then went Clinical_event to local Nonbiological_location hospital Nonbiological_location where intervention Therapeutic_procedure was done to control bleeding Sign_symptom and symptomatic Therapeutic_procedure treatment Therapeutic_procedure was done with intravenous Administration fluid Medication and blood Therapeutic_procedure transfusion Therapeutic_procedure .
He finally referred Clinical_event to our hospital Nonbiological_location for further evaluation.
Intermediate Severity rectal Biological_structure bleeding Sign_symptom of fresh Detailed_description blood Detailed_description was presented on admission Clinical_event .
Patient complained of dizziness Sign_symptom on standing Detailed_description , shortness Sign_symptom of Sign_symptom breath Sign_symptom , and palpitation Sign_symptom on walking Detailed_description a Detailed_description short Detailed_description distance Detailed_description .
There was no Family_history history Family_history of Family_history similar Family_history illness Family_history in Family_history family Family_history .
On general Diagnostic_procedure examination Diagnostic_procedure , patient appeared pale Sign_symptom , but his heart Diagnostic_procedure rate Diagnostic_procedure and blood Diagnostic_procedure pressure Diagnostic_procedure were within Lab_value normal Lab_value limit Lab_value during rest.
He lost Lab_value 5 Lab_value   kg Lab_value of his body Diagnostic_procedure weight Diagnostic_procedure during Duration last Duration 5 Duration months Duration .
On rectal Diagnostic_procedure examination Diagnostic_procedure , fresh Sign_symptom blood Sign_symptom was seen around Biological_structure anal Biological_structure region Biological_structure and soft Texture mass Sign_symptom was felt on digital Diagnostic_procedure rectal Diagnostic_procedure examination Diagnostic_procedure .
On proctoscopy Diagnostic_procedure , anal Biological_structure cavity Biological_structure and rectum Biological_structure were seen filled with fresh Sign_symptom blood Sign_symptom , but active Sign_symptom site Sign_symptom of Sign_symptom bleeding Sign_symptom , polyp Sign_symptom , or ulcer Sign_symptom was not detected.
On laboratory Diagnostic_procedure examination Diagnostic_procedure , red Diagnostic_procedure blood Diagnostic_procedure cell Diagnostic_procedure count Diagnostic_procedure was 3.09 Lab_value   × Lab_value   1012/L Lab_value (Normal: 4.32–5.72 × 1012/L) and hemoglobin Diagnostic_procedure was 86 Lab_value   g/L Lab_value (Normal: 135–175 g/L).
All Diagnostic_procedure other Diagnostic_procedure parameters Diagnostic_procedure were within Lab_value normal Lab_value limit Lab_value .
None Detailed_description enhanced Detailed_description CT Diagnostic_procedure showed isodense Detailed_description ( 35 Lab_value   HU Lab_value ) homogenous Detailed_description bowel Biological_structure wall Biological_structure thickening Sign_symptom that on contrast Detailed_description - enhanced Detailed_description CT Diagnostic_procedure venous Detailed_description phase Detailed_description enhances Sign_symptom heterogeneously Detailed_description .
Multiple Detailed_description calcifications Sign_symptom were seen in the thickened Biological_structure bowel Biological_structure wall Biological_structure and around the peri Biological_structure - rectal Biological_structure area Biological_structure .
Lesion Sign_symptom was seen extending from distal Biological_structure sigmoid Biological_structure to whole Biological_structure of Biological_structure the Biological_structure rectum Biological_structure (Fig.1).
Multiple Detailed_description hypodense Detailed_description lesions Sign_symptom were also seen in spleen Biological_structure (Fig.2).
After initial management Therapeutic_procedure of anemia Sign_symptom , the patient underwent abdominal Biological_structure laparotomy Therapeutic_procedure followed by surgical Therapeutic_procedure excision Therapeutic_procedure .
During surgery, 25 Distance   cm Distance long lesion Sign_symptom was found extending from distal Biological_structure sigmoid Biological_structure to whole Biological_structure of Biological_structure the Biological_structure rectum Biological_structure .
Whole Biological_structure of Biological_structure the Biological_structure rectum Biological_structure and part Biological_structure of Biological_structure the Biological_structure sigmoid Biological_structure colon Biological_structure were excised Therapeutic_procedure and sigmoid Detailed_description - anus Detailed_description anastomosis Therapeutic_procedure was done.
Postsurgical histopathological Diagnostic_procedure examination Diagnostic_procedure of excised Detailed_description specimen Detailed_description showed submucosal Detailed_description multiple Detailed_description thin Detailed_description - walled Detailed_description vessel Detailed_description of varying Lab_value size Lab_value with interposed Lab_value stroma Lab_value .
Some Lab_value vessels Lab_value lumen Lab_value consisted Lab_value of Lab_value blood Lab_value cells Lab_value (consistent with blood vessel), whereas other Lab_value consisted Lab_value of Lab_value clear Lab_value fluid Lab_value (consistent with lymph vessel).
Immunohistochemistry Diagnostic_procedure of specimen showed endothelial Biological_structure cells Biological_structure positive Lab_value for CD Diagnostic_procedure 31 Diagnostic_procedure and CD Diagnostic_procedure 34 Diagnostic_procedure .
Some Biological_structure cells Biological_structure were positive Lab_value for D2–40, while others Biological_structure were negative Lab_value for D2–40 (Fig.3).
On the basis of histopathological report and immunohistochemistry, hemolymphangioma Disease_disorder was diagnosed.
The surgery, which followed by complication ( intestinal Biological_structure infection Disease_disorder ), was well managed Therapeutic_procedure and the patient was discharged Clinical_event from hospital Nonbiological_location on the 23rd Date day Date of surgery.
Then after, no further complication Sign_symptom or recurrence Sign_symptom was noticed during 6 Duration months’ Duration follow Clinical_event - up Clinical_event .
This study was approved by the First Affiliated Hospital of Sun Yat-Sen University Institutional Review Board.
Written consent for this case report was obtained from the patient.