The presentation of Crohn's disease with acute massive gastrointestinal hemorrhage

Kuan‐Chieh Lee, Chia‐Jung Kuo, Jeng‐Hwei Tseng, Ming‐Yao Su, Cheng‐Tang Chiu, Shih‐Chiang Huang, Shih‐Ching Kang
2020 Advances in Digestive Medicine  
Severe GI hemorrhage is a rare initial presentation in Crohn's disease and poses a therapeutic challenge for clinical care. Currently there is no conclusive consensus or guideline on the treatment modalities for Crohn's disease -related gastrointestinal bleeding. We present the case of a 21-year-old man with acute lower gastrointestinal bleeding who accepted transcatheter arterial embolization to attain hemostasis. After one day later of embolization, intractable abdominal pain happened and
more » ... gent laparoscopic exploration was arranged. Operation finding reported stenosis and chronic inflammation changes near ileal-cecal valve. Besides, several bleeding sites and perforation are detected which is different from splanchnic branch of embolization. Pathology of resected bowel reported transmural acute and chronic inflammation with fibrin and purulent exudates are showed on the serosa. Crohn's disease is favored. In Crohn's disease, most common bleeding site in literature is located at descending and sigmoid colon. To attain hemostasis, some literatures raise concerns about embolic-related complication of intestinal infarction. We would like to share a case of unusual bleeding site and provide consideration of embolization as an option for the treatment of Crohn's disease. This article is protected by copyright. All rights reserved.
doi:10.1002/aid2.13189 fatcat:mtmkzpah2vel5jxrnurzqzemyq