Teleangiectasia – Example
Author: Prof. em. Dr. med. S. Liebe, University Hospital Rostock, Rostock, Germany
From: Falk Media Service D34, Endoscopy Practice on Video - Selected Diseases of the Colon
2. Edition 2012. © Falk Foundation e.V. All rights reserved.
This 79-year-old white female patient had undergone pelvic radiation for the treatment of uterine carcinoma about one year prior to examination. The patient was referred for colonoscopy after the sudden appearance of bloody stools. During preparation for the procedure, the patient continued to pass bloody stool. Circulation remained stable.
After Argon Plasma Coagulation
The video recording shows the patient’s status after one week and several argon plasma coagulation treatments. At these examinations further bleeding teleangiectatic lesions were identified and treated. After one week, complete hemostasis has been achieved. The mucosa is pale and there are multiple ulcerations secondary to argon plasma coagulation. At the margins of the ulcerations one sees remaining areas of teleangiectasis that had been missed during the argon plasma coagulation treatments. The changes are restricted to the sigmoid colon.
Chronic radiation injury becomes manifest between six and 12 months after radiation exposure. The mucosa is pale and dull. There is neovascularization in the form of teleangiectasis and these lesions can be very vulnerable. During the phase of active bleeding, evaluation of the finer structures is not possible.
As long as active bleeding is ongoing, evaluation of fine structures is limited. Based on her history, the suspected diagnosis of “bleeding from teleangiectasis secondary to radiation colitis” was alredy made at the first examination and confirmed in subsequent examinations. (see also Videoclip 1: Bleeding Teleangiectasis after Radiation)