A Case of Colonic Crohn's Disease, Presenting Massive Bleeding and Showing Resistance to Conservative Treatment

Mikio Imamura, Hiroto Nakajima, Hidemi Yamauchi

Department of Surgery, National Sendai Hospital

We have experienced a case of colonic Crohn's disease, presenting massive bleeding preoperatively. The patient was a 15-year-old male who was admitted to our hospital with chief complaints of fever, watery diarrhea and bloody stool. Barium-enema demonstrated the absence of haustra, and a cobblestone like appearance at the transverse colon. Biopsy specimens showed multiple crypt abscesses, but no granuloma. In spite of intensive care with intravenous hyperalimentation and administration of salazosulfapyridine and predonisolone, his general condition became worse, and there was further shock due to massive bleeding from the colonic lesion. Subsequently, he underwent resection of the transverse colon with an end-to-end anastomosis. The lesion, located in the transverse colon, had a cobblestone appearance and was covered with a large amount of coagula, but had a clear margin. Microscopically, epitheloid granulomas were observed together with multinuclear giant cells in addition to crypt abscesses, leading to the final diagnosis of colonic Crohn's disease.

Key words
massive bleeding, indeterminate colitis, colonic Crohn's disease

Reprint requests
Mikio Imamura Department of Surgery, National Sendai Hospital
2-8-8 Miyagino, Miyagino-ku, Sendai, 983 JAPAN

Accepted
July 6, 1994

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