Pediatr Gastroenterol Hepatol Nutr.  2013 Mar;16(1):53-60. 10.5223/pghn.2013.16.1.53.

Life-Threatening Lower Gastrointestinal Hemorrhage in Pediatric Crohn's Disease

• Kim E
• Kang Y
• Lee MJ
• Park YN
• Koh H

• KMID: 1428808
• DOI: http://doi.org/10.5223/pghn.2013.16.1.53

Abstract

In Crohn's disease, mild gastrointestinal bleeding often occurs; however massive gastrointestinal hemorrhage, which can have a dramatic effect on a patient's vital sign, is rare. This could result in potentially life-threatening complications, which can lead to death. Massive hemorrhagic Crohn's disease is not well known and for this reason, they are a diagnostic and therapeutic challenge. Various diagnostic and therapeutic methods are currently being developed and used. The surgical method is often used only as a last measure since this approach has the risk of serious complications that may endanger patients. However, if massive bleeding continues even after all therapeutic methods are used, the surgical method must be implemented. In this case, all therapeutic methods were found to be ineffective; therefore, surgery was used as a last option. Ultimately, the surgical method was found to be successfully used to treat life-threatening hemorrhagic Crohn's disease.

Keyword

Gastrointestinal hemorrhage; Pediatric Crohn's disease; General surgery

MeSH Terms

Crohn Disease
Gastrointestinal Hemorrhage
Hemorrhage
Humans
Vital Signs
Crohn Disease

Figure

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  Fig. 1 The 1st colonoscopy. Multiple linear deep ulcerations, cobble stone appearance and pseudo-polyp at terminal ileum, which are consistent with Crohn's disease.

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  Fig. 2 The 2nd colonoscopy. Current active bleeding was not observed and no other bleeding focus was found in the scope.

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  Fig. 3 The 1st superior mesenteric angiography shows increased focal staining in the ileocecal valve and proximal ascending colon.

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  Fig. 4 Two superior mesenteric artery branches were selected and arterial embolization was performed.

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  Fig. 5 The 2nd superior mesenteric angiography shows a hypervascular blush in the ileocecal valve and proximal ascending colon.

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  Fig. 6 Specimen from ileocecal resection. Erythematous and multiple ulceration, transmural inflammation with perforation and small non-caseating granuloma are shown, a condition that is compatible with Crohn's disease.

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