Massive lower gastrointestinal hemorrhage in Crohn’s disease

  • Joshua R. Korzenik

Opinion statement

Acute lower gastrointestinal bleeding is an uncommon but potentially life-threatening complication of Crohn’s disease. Because of the relative infrequency of severe bleeding due to CD, reports of larger numbers of cases are few, and the medical literature provides insufficient information to direct management. Nevertheless, certain clear guidelines can be offered once other causes for GI blood loss have been excluded and the diagnosis of a Crohn’s-related bleed is likely. While the initial episode may abate spontaneously, the primary treatment is determined by the severity and persistence of bleeding as well as the risk for recurrence.
  • Localization of the site of bleeding is essential whether endoscopic therapy, surgery, or medical management is attempted.

  • Endoscopic evaluation is preferable, if feasible, as it will provide a broader assessment of extent of disease as well as having a reasonable likelihood of identifying the site of bleeding with possible therapeutic intervention.

  • An angiogram can be a useful alternative, but therapeutic intervention with embolization should be avoided because of the risk for intestinal infarction. Surgery remains the standard of care for persistent severe acute bleeds.

  • If the acute bleeding ceases, an interval to attempt pharmacologic therapy may be available, permitting treatment of the underlying Crohn’s disease. Newer therapies such as infliximab, which may produce relatively rapid mucosal healing, may be beneficial; while they offer hopeful treatment alternatives, they have not been demonstrated to be of use for these cases.


Infliximab Endoscopic Therapy Bleeding Site Mucosal Healing Injection Sclerotherapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Driver C, Anderson D, Keenan R: Massive intestinal bleeding in association with Crohn’s disease. J R Coll Surgy Edinb 1996, 41:152–154.Google Scholar
  2. 2.
    Cirocco W, Reilly J, Rusin L: Life-threatening hemorrhage and exsanguination from Crohn’s disease. Dis Colon Rectum 1995, 38:85–95.PubMedCrossRefGoogle Scholar
  3. 3.
    Belaiche J, Louis E, D’Haens G, et al.: Acute lower gastrointestinal bleeding in Crohn’s disease: Characteristics of a unique series of 34 patients. Am J Gastroenterol 1999, 94:2177–2181. This represents the larest series of patients to date with massive lower GI bleeding in Crohn’s disease; well detailed and reported.PubMedCrossRefGoogle Scholar
  4. 4.
    Homan W, Tang C, Thorbjarnarson B: Acute massive hemorrhage from intestinal Crohn’s disease. Arch Surg 1976, 111:901–905.PubMedGoogle Scholar
  5. 5.
    Carona F, Dyck W: Massive gastrointestinal hemorrhage as the sole clinical manifestation of regional enteritis. Dig Dis 1973, 18:1001–1004.CrossRefGoogle Scholar
  6. 6.
    Robert J, Sachar D, Greenstein A: Severe gastrointestinal hemorrhage in Crohn’s disease. Ann Surg 1990, 213:207–211.CrossRefGoogle Scholar
  7. 7.
    Pardi D, Loftus E, Tremaine W, et al.: Acute major gastrointestinal hemorrhage in inflammatory bowel disease. Gastrointest Endosc 1999, 49:153–157. A recent series that reports similar findings to the Belgian series, reinforcing the major premises.PubMedCrossRefGoogle Scholar
  8. 8.
    Asakura H, Takagi T, Kobayashi K, et al.: Microangiographic findings in massive intestinal bleeing in a patient with Crohn’s disease. Angiology 1985, 36(11):802–807.PubMedGoogle Scholar
  9. 9.
    Wakefield A, Sawyerr A, Dhillon A, et al.: Pathogenesis of Crohn’s disease: multifocal gastrointestinal infarction. Lancet 1989, 2:1057–1062.PubMedCrossRefGoogle Scholar
  10. 10.
    McGarrity T, Manasse J, Koch K, Weidner W: Crohn’s disease and massive lower gastrointestinal bleeding: Angiographic appearance and two case reports. Am J Gastroenterol 1987, 82:1096–1099.PubMedGoogle Scholar
  11. 11.
    Smith-Behn J, Banez A, et al.: Acute massive rectal bleeding as a presenting sign of Crohn’s disease. N Y State J Med 1988, 88:545–546.PubMedGoogle Scholar
  12. 12.
    Sans M, Llach J, Bordas J, et al.: Life-threatening hemorrhage: An unusual form of presentation of Crohn’s disease treated with endoscopic injection sclerotherapy. Endoscopy 1998, 30:S83-S84.PubMedCrossRefGoogle Scholar
  13. 13.
    Mellor J, Chandler G, Chapman A, Irving H: Massive gastrointestinal bleeding in Crohn’s disease: successful control by intrarterial vasopressin infusion. Gut 1982, 23:872–874.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2000

Authors and Affiliations

  • Joshua R. Korzenik
    • 1
  1. 1.Washington University School of MedicineSt. LouisUSA

Personalised recommendations