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Published on: October 29, 2014
Severe gastrointestinal bleeding in Crohn's disease
M Veroux1, I Angriman, C Ruffolo
1Dipartimento di Chirurgia, Sezione di Chirurgia d Urgenza e Generale, Azienda Ospedaliera Vittorio Emanuele, Catania.
Insights
Acute gastrointestinal bleeding is a rare complication of Crohn's disease. Diagnosis can be challenging, and while surgery is often necessary, conservative management may be appropriate in some cases.
Area of Science:
- Gastroenterology
- Inflammatory Bowel Disease
- Surgical Gastroenterology
Background:
- Acute gastrointestinal bleeding is an uncommon manifestation of Crohn's disease.
- This study focuses on characterizing such rare cases.
Purpose of the Study:
- To analyze the clinical features and outcomes of acute gastrointestinal bleeding in patients with Crohn's disease.
- To evaluate diagnostic and therapeutic strategies for this condition.
Main Methods:
- Retrospective review of five patients with Crohn's disease and gastrointestinal bleeding from 1992 to 2000.
- Analysis of diagnostic procedures (endoscopy, enteroscopy) and treatment outcomes (surgical vs. conservative).
Main Results:
- Gastrointestinal bleeding occurred in five patients with a mean disease duration of 6 years.
- Bleeding sources were identified in 80% of cases, with endoscopy being the initial diagnostic tool.
- Three patients underwent colectomy, two were managed conservatively, and one experienced recurrent bleeding.
Conclusions:
- Gastrointestinal bleeding in Crohn's disease is rare and its site can be difficult to pinpoint preoperatively.
- Enteroscopy is recommended for diagnosis, and surgery is indicated in approximately half of the cases.
- Recurrent bleeding is a strong indication for surgical intervention.
Introduction:
Acute gastrointestinal bleeding is rare in Crohn's disease.
Methods:
We characterized the clinical features and course of such hemorrhage in patients seen at our institution from 1992 to 2000.
Results:
Five patients had gastrointestinal bleeding during Crohn's disease. All patients had a known Crohn's disease, with a mean duration of the disease of 6 years. The source of bleeding was identified in four patients (80%). Endoscopy was, in all patients, the first diagnostic procedure. An Hartmann total colectomy with closure of the rectal stump and ileostomy was performed in three patients, while two patients with ileal massive bleeding were treated conservatively. One patient had a recurrence of bleeding from the small bowel one week later but he didn't required surgical treatment. One patient with pancolic Crohn's disease died on 10th postoperative day because of multiorgan failure and septic complications.
Conclusions:
Gastrointestinal bleeding is rare in Crohn's disease, with a predilection for site of involvement. The preoperative diagnosis of the site of bleeding is not easy, and enteroscopy should be mandatory in such patients. Surgery is required for half of cases and recurrent haemorrhage should be an appropriate indication for surgery.
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