PMC5573779_01
(A) Flat bluish sub-mucosal serpentine vessels on colonoscopy. (B) Normal superior rectal artery and slight lamellar tumor stain on angiography. (C) Enhanced thickened rectal wall and serpentine enlarged vessels in the rectal mesentery with multiple calcification in pelvic on CTV. (D) T1W axial. (E) T2W axial. Thickening of the rectal wall with serpentine enlarged vessels in the rectal mesentery intermediate signal intensity on T1W and significantly hyperintense on T2W image.
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Colonoscopy, pelvic magnetic resonance imaging (MRI), abdominal computed tomography (CT) and digital subtraction angiography (DSA) were done subsequently, which confirmed the diagnosis of DCHR, extending from the dentate line to 5 cm proximally (Fig. 1).
(A) Transanal single-incision laparoscopic surgery port (Covidien, Mansfield, MA). (B) Transanal total mesorectal posterior dissection. (C) Surgical specimen with complete mesorectum. (D) A protecting ileostomy.
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A loop ileostomy was also constructed for the protection of the anastomosis (Fig. 2). The histopathological features of excised specimen, the mesorectum of which was classified as complete, were an increased amount of dilated, thin-walled blood vessels in the submucosa, muscular layer, serosa and mesorectum (Fig. 2).