Hemorrhagic Shock Presenting as the First Manifestation of Inflammatory Stricturing Crohn's Disease

While hematochezia is common in Crohn's disease (CD), severe gastrointestinal hemorrhage causing hemodynamic instability is rare. Strictures, another frequent complication, usually cause obstructive symptoms. We report the first case of hemorrhagic shock from ulcerated ileal strictures as the initial presentation of CD. Standard endoscopy and abdominal imaging did not identify the bleeding source, but capsule endoscopy detected ulcerated strictures confirmed by double-balloon enteroscopy. The patient underwent small bowel resection to reduce rebleeding risk and was started on anti-tumor necrosis factor therapy. This atypical presentation of stricturing CD with hemorrhagic shock underscores the importance of small bowel enteroscopy in guiding clinical decisions.