LIFE-THREATENING HEMORRHAGE AND EXSANGUINATION FROM CROHNS-DISEASE - REPORT OF 4 CASES

PURPOSE AND METHODS: From 1979 through 1991, four patients of 631 admi ssions (0.6 percent) for Crohn's disease in Erie, Pennsylvania, presen ted with life-threatening gastrointestinal hemorrhage. These and 34 si milar cases from the medical literature were reviewed to provide a com posite of those at risk and elucidate appropriate diagnostic and thera peutic maneuvers. RESULTS: The study revealed a preponderance of young men (2:1 ratio) with an average age of 35 (range, 14-89) years, the m ajority of whom had known Crohn's disease (60 percent) for an average of 4.6 (range, 0-18) years. The site of bleeding resembled the general distribution for Crohn's disease, with small bowel disease predominat ing (66 percent involved the ileum). The five cases of exsanguination (13 percent of the total) were all men with known Crohn's disease (ave rage, 5.8 years) involving the ileum alone or in part. Mesenteric arte riography was positive in 17 patients, providing precise preoperative localization resulting in no mortality in this group. Excluding those who presented with exsanguination, surgery was necessary to cease hemo rrhage in 91 percent (30/33) of patients. Ileocolectomy was the most f requently performed procedure (53 percent). Zn follow-up, only one pat ient required further surgical resection for recurrent bleeding (3.5 p ercent), and two other patients (7 percent) required further therapy f or nonhemorrhagic recurrence. CONCLUSION: Crohn's disease may be respo nsible for life-threatening gastrointestinal hemorrhage and even exsan guination. Many of the characteristics of these patients resemble the general Crohn's disease population. Surgical resection provides excell ent palliation. A long-term benign course can be expected in this subg roup of Crohn's disease patients.