A Case of Crohn Disease with Massive Hemorrhage Treated Using Emergency Surgery

Abstract

Massive hemorrhage is a rare complication of Crohn disease. Although conservative treatment often produces favorable results, we report a case of Crohn disease with massive hemorrhage that was treated using emergency surgery. A 32-year-old man was diagnosed by a local medical doctor as having Crohn disease of the large intestine and was treated using an administration of mesalazine and an alimental diet. However, the patient was subsequently admitted to hospital because of severe abdominal pain. He was treated with intravenous hyperalimentation, but he subsequently developed melena. A colonoscopy showed an exposed vessel in a longitudinal ulcer within the sigmoid colon. The vessel was clipped and tattooed. On the following day, the melena recurred, and his blood pressure gradually decreased. Consequently, the patient underwent emergency surgery. Operative findings showed thickening and redness in the lower sigmoid colon. The sigmoid colon was partly cut to confirm the site of bleeding, and an expansive and exposed vessel was detected. We performed a wedge resection of the sigmoid colon and ligated the arterial branch that appeared to be a feeder from the serous membrane. The patient has not experienced any other bleeding for eleven months since the surgery.