Giant Colonic Cavernous Hemangioma Causing Hematochezia in a 14-Year-Old Boy

A 14-year-old boy presented with intermittent hematochezia for 2 weeks. He reported a similar episode of hematochezia 1 year ago that was regarded as colitis. His medical history was unremarkable. Physical examination showed a nontender, soft, palpable mass at the upper right quadrant of the abdomen. His hemoglobin level was 7.3 g/dL (normal range, 13.0–16.0 g/dL). A computed tomography scan of his abdomen showed asymmetric segmental wall thickening with scattered punctuate calcification (Figure A, white arrow) and heterogeneous enhancement from the midtransverse colon to the hepatic flexure (Figure A, black arrow). Colonoscopy showed the huge bluish protruding mass with a conglomerated grape-like shape and hemocystic spots that occupied most of the lumen of the midtransverse colon (Figures B and C). An endoscopic biopsy was not performed because of the high risk of significant bleeding after biopsy of the lesion. The patient underwent a laparoscopic right hemicolectomy. Surgical histology showed the tissue was composed of large vessels with a cystically dilated lumen and thin wall compatible with cavernous hemangioma (Figure D). After surgical resection, the patient was discharged without any complications.