Intestinal Crohn's Disease in Shock with Acute Massive Hemorrhage as the First Symptom; Report of a Case

Mikio Yasumura, Tatsumi Iida, Masahiro Goto, Masanao Okada, Katsutoshi Murase, Tomoo Mizutani, Naoki Futamura^* and Kenichi Sakamoto^*

Department of Surgery, JA Yoro Central Hospital, First Department of Surgery, Gifu University School of Medicine^*

We report small intestinal Crohn's disease presenting with acute major rectal bleeding as the first symptom of the disease. A 16-year-old boy was admitted with a history of bloody stools followed by a syncopal episode. After admission, esophagogastroscopy and sigmoidoscopy were conducted with normal results. Superior mesenteric arteriogram revealed the extravasation of dye into the lumen of bowel from ileal branches. After 10 units of blood were transfused, he was taken to surgery on the fourth hospital day. Changes characteristic of Crohn's disease about 80 cm 40 cm proximal to the ileocecal valve were found and removel. Pathologic examination showed a 65- cm serial longitudinal ulceration and 2 small ulcers in the ileum. Microscopic sections showed transmural inflamation and multinucleated giant cells without central caseous necrosis. It is not generally appreciated that life-threatening hemorrhage may complicate Crohn's disease. The boy remained well for 6 years and 7 months without recurrent bleeding or other complications.

Key words
Crohn's disease, massive bleeding

Reprint requests
Mikio Yasumura First Department of Surgery, Gifu University School of Medicine, 40 Tsukasa-machi, Gifu City, 500-8705 JAPAN

Accepted
December 12, 2001

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