Massive per rectal bleeding following blunt abdominal trauma: First presentation of Crohn's disease

Inflammatory bowel disease is a chronic and relatively common disorder with heterogeneous presentation. Peak incidence occurs in the second and third decades of life. We present a patient with Crohn's disease whose first presentation was profuse bleeding/rectum following blunt abdominal trauma.

A 29 year old previously healthy man presented one hour after sustaining relatively mild abdominal trauma, due to fall onto the ball during a rugby match. He complained of abdominal pain and one episode of large fresh rectal bleeding. He was pale and distressed with hypotension, tachycardia and abdominal guarding & fresh blood on digital rectal examination. With a provisional diagnosis of intestinal injury he was taken to theatre. Right hemi-colectomy was done for a thickened and inflamed segment of distal ileum, a large adjacent mesenteric haematoma & mesenteric lymph nodes and blood in distal bowel. Histology confirmed the features of Crohn's disease.

Crohn's disease is unusual cause of massive lower gastrointestinal bleeding occurring in 0.9-6% of patients. Rectal bleeding associated with diarrhoea is relatively more common than massive bleeding. The presence of Crohn's disease in young patients presenting like this is unlikely to be suspected and diagnosis could only be made after laparotomy.