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Massive intestinal bleeding in association with Crohn's disease
C P Driver1, D N Anderson, R A Keenan
1Aberdeen Royal Hospitals NHS Trust, Foresterhill, UK.
Insights
Massive rectal bleeding is a rare but serious complication of Crohn's disease (CD). This study highlights challenges in identifying bleeding sites and significant patient morbidity and mortality associated with surgical treatment.
Area of Science:
- Gastroenterology
- Colorectal Surgery
Background:
- Crohn's disease (CD) is a chronic inflammatory bowel disease.
- Massive rectal bleeding is an uncommon but severe complication of CD.
Observation:
- A 20-year review identified 10 patients with significant rectal bleeding requiring transfusion.
- Pre-operative bleeding site identification was successful in only one patient.
- Colonic origin was confirmed in 90% of cases.
Findings:
- All 10 patients underwent surgery, with 7 requiring a stoma.
- Recurrent bleeding occurred in one patient.
- Early post-operative mortality was 20%.
Implications:
- Massive rectal bleeding in CD presents diagnostic and therapeutic challenges.
- Surgical intervention is often necessary but associated with high morbidity.
- Improved pre-operative localization strategies are needed for better patient outcomes.
Abstract:
Five hundred and one patients with Crohn's disease, presenting to a single surgical unit during a 20-year period, were reviewed by utilizing a computerized audit system. Ten patients were identified with rectal bleeding significant enough to require a blood transfusion to maintain cardiovascular homeostasis. The site of bleeding was correctly identified pre-operatively in only one patient, and at the time of surgery in only four patients. In nine (90%) of the 10 cases, the origin of the bleeding was subsequently found to be colonic. All 10 patients were treated surgically, with seven patients requiring fashioning of a stoma, none of whom had gastro-intestinal continuity subsequently re-established. Recurrent bleeding occurred in a single patient. The early post-operative mortality was 20%. Massive rectal bleeding remains an uncommon complication of Crohn's disease, and still carries significant morbidity and mortality. Pre-operative localization of the site of bleeding is uncommon, making intra-operative identification of the bleeding area difficult.