Emergent Surgical Treatment of Five Cases with Massive Lower Gastrointestinal Bleeding in Crohn's Disease

Motoi Koyama, Takayuki Morita, Akihiko Murata and Mutsuo Sasaki

Second Department of Surgery, Hirosaki University School of Medicine

We experienced five cases (mean age 25.8 years; 4 males, 1 female) in which emergent surgery was performed for the treatment of acute massive lower gastrointestinal bleeding in patients with Crohn's disease. The location of the bleeding was the small intestine in 2 cases, the small and large intestine in 2 cases, and the large intestine in one case. The mean amount of hemorrhage was 3,100 ml, and an average of 2,040 ml of blood was required per patient. We performed an intra-operative colonoscopy in one case where the bleeding point had not been detected. A short resection margin involving the bleeding point was planned. Macroscopically, the bleeding sites appeared as serpiginous, scattered and deep longitudinal ulcers. The pathological findings suggested that the severe hemorrhages had resulted from ulceration extending into the submucosal or transmural layers and the erosion of moderate-sized vessels. These cases suggest that careful follow-up and treatment is required in younger patients with Crohn's disease who have serpiginous, scattered and deep longitudinal ulcers that could lead to life-threatening hemorrhage.

Key words
Crohn's disease, massive bleeding, emergent operation

Reprint requests
Motoi Koyama Second Department of Surgery, Hirosaki University School of Medicine
5 Zaifu-cho, Hirosaki, 036-8562 JAPAN

Accepted
September 24, 2003

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