Massive, life-threatening bleeding in Crohn's disease

Abstract

Background: Acute lower gastrointestinal bleeding is a rare complication in Crohn's disease (CD).

Materials and methods: We characterized the clinical features and course of such bleeding in six of 156 patients with CD, treated between 1985 and 2003 at our institution. The data on the patients were gathered through retrospective data analysis.

Results: The six patients discussed here consisted of three males and three females, ranging in age from 17 to 42 years. Three patients were known to have CD, whereas three presented with acute bleeding, as the initial symptom of CD. There were 11 separate episodes of severe hemorrhage: three patients bled only once, two bled twice, and one bled four times. The precise bleeding site was correctly identified in four of eleven episodes: twice by colonoscopy and twice by angiography. Primary bleeding episodes subsided without surgery in four of six patients, but three of these four patients re-bled massively, and surgery followed in two of these cases. An emergency surgery was necessary to stop the hemorrhage in four patients; two of them underwent surgery during their first haemorrhagic episodes, and two patients underwent surgery during a repeated episode of hemorrhage. As a consequence, one ileectomy and three ileocolectomies had to be performed. During follow-up of the resected patients, no recurrence of haemorrhagic or non-haemorrhagic CD was observed in three patients two, five, and six years after surgery and only one patient required further therapy three years after surgery for recurrent bleeding. For this, super selective embolization of the periphery branch of the superior mesenteric artery was used. Two non-resected patients are doing well in a course of remission.

Conclusion: A conservative approach may be suggested as first-line therapy, but surgery is inevitable in patients suffering from massive bleeding and in patients with recurrent bleeding.