Combination of Colonoscopy and Clip Application with Angiography to Mark Vascular Malformation in the Small Intestine

Figure 1 A 55-year-old woman was admitted with chronic recurrent lower gastrointestinal bleeding. Previous examinations, including esophagogastroduodenoscopy and colonoscopy, during an active bleeding episode, revealed no bleeding site. Angiography showed a vascular malformation in projection to the right sided colon or neoterminal ileum (arrow).

Figure 2 With this lesion in mind one suspicious lesion was found 40 cm beyond the ileocolonic anastomosis (arrows). The lesion was marked with a clip.

Figure 3 A second angiography was performed, which confirmed the correct identification of the vascular malformation since the clip was visible in projection to the angiographically identified lesion (arrow). In addition, a second vascular malformation was detected during this angiography, which could not be reached by the endoscope. Thus, endoscopic treatment was not practical and surgery was performed.