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Crohn's disease and massive lower gastrointestinal bleeding: angiographic appearance and two case reports
T J McGarrity1, J S Manasse, K L Koch
1Department of Medicine, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey.
Insights
Two Crohn's disease patients experienced severe lower gastrointestinal bleeding. Both required surgical intervention after medical management failed, highlighting surgical resection as a necessary treatment for this complication.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
- Surgical Oncology
Background:
- Crohn's disease is a chronic inflammatory bowel disease.
- Massive lower gastrointestinal bleeding is an uncommon complication of Crohn's disease.
- Early diagnosis and effective management are crucial for patient outcomes.
Observation:
- Two cases of massive lower gastrointestinal bleeding in Crohn's disease patients are presented.
- Case 1: Bleeding localized to the ileum via angiography showing contrast extravasation.
- Case 2: Nuclear medicine scan identified ileal bleeding using labeled red blood cells.
Findings:
- Medical management was ineffective in both patients.
- Surgical resection of the affected bowel segment was required to control bleeding.
- Angiographic findings in Crohn's disease can indicate active bleeding.
Implications:
- This study emphasizes the potential for severe gastrointestinal hemorrhage in Crohn's disease.
- Highlights the diagnostic utility of angiography and nuclear medicine in identifying bleeding sources.
- Underscores the necessity of surgical intervention when conservative measures fail.
Abstract:
Massive lower gastrointestinal bleeding is described in two patients with Crohn's disease. In case 1, extravasation of contrast material from the ileal branch of the ileocolic artery was seen during selective angiography. In case 2, results of an in vitro labeled 99Tc pyrophosphate red blood cell scan localized bleeding to the ileum. In both cases, medical management was unsuccessful, and surgical resection of the affected bowel was required to stop the bleeding. Angiographic appearance of Crohn's disease is discussed, and a review of the literature of this unusual feature of Crohn's disease is presented.