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Massive, life-threatening bleeding in Crohn's disease
1Department of Surgery of Faculty Hospital Královské Vinohrady and 3rd Faculty of Medicine, Prague, Czech Rep. kosrod@seznam.cz
Insights
Acute lower gastrointestinal bleeding is a rare complication of Crohn's disease (CD). A conservative approach is recommended initially, but surgery is often necessary for severe or recurrent bleeding in CD patients.
Area of Science:
- Gastroenterology
- Internal Medicine
- Surgical Gastroenterology
Background:
- Acute lower gastrointestinal bleeding is an infrequent complication in Crohn's disease (CD).
- Understanding the clinical course and management of this complication is crucial for patient outcomes.
Purpose of the Study:
- To characterize the clinical features and outcomes of acute lower gastrointestinal bleeding in patients with Crohn's disease.
- To evaluate the effectiveness of conservative and surgical management strategies.
Main Methods:
- Retrospective analysis of six patients with Crohn's disease experiencing acute lower gastrointestinal bleeding between 1985 and 2003.
- Data collection included patient demographics, bleeding episodes, diagnostic methods, and treatment outcomes.
Main Results:
- Six patients (3 male, 3 female; ages 17-42) experienced 11 severe hemorrhage episodes.
- Four patients required emergency surgery, including three ileocolectomies and one ileectomy.
- Three of four patients initially treated conservatively re-bled, necessitating surgery. Two non-resected patients achieved remission.
Conclusions:
- A conservative approach can be the initial management strategy for acute lower GI bleeding in CD.
- Surgical intervention is inevitable for patients with massive or recurrent bleeding episodes.
- Surgical outcomes were favorable, with no recurrence of CD-related bleeding in most resected patients.
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.
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