Skip to main content Skip to main navigation menu Skip to site footer

Profuse haematochezia related to Crohn’s disease: a rare case report

  • Dilly Niza Paramita ,
  • Budi Widodo ,
  • Heriyawati Heriyawati ,

Abstract

Background: Lower gastrointestinal bleeding (LGIB) can be caused by irritable bowel disease. Haematochezia is one of the LGIB symptoms. Profuse haematochezia is a rare complication in Crohn’s disease.

Case Presentation: We reported a 24-year-old patient with profuse haematochezia with severe anaemia and hypovolemic shock. Anamnesis, physical examination and colonoscopy showed that haematochezia was caused by Crohn’s disease. Colonoscopy was done after the patient was hemodynamically stable with findings of external haemorrhoid and multiple ulcers with varying size (0.5–2 cm) on ascending colon, caecum and terminal ileum. The tissue histopathology of ileocecal junction indicated intestinal epithelia with partially eroded, crypts infiltrated by inflammatory cells, swollen lamina propria with proliferation and dilation of blood vessels indicting the Crohn’s disease. The patient then treated with Crohn’s disease medical therapy including low dose oral steroid, sulfasalazine and antibiotics. Clinical improvement was found on one week follow-up after discharge from hospital.

Conclusion: Profuse haematochezia could be associated with Crohn’s disease and the comprehensive approaches should be taken to manage the Crohn’s disease with such presentation.

References

  1. Rockey DC. Lower Gastrointestinal Bleeding. Gastroenterology. 2006;130(1):165–71. Available from: http://dx.doi.org/10.1053/j.gastro.2005.11.042
  2. Oakland K. Changing epidemiology and etiology of upper and lower gastrointestinal bleeding. Best Pract Res Clin Gastroenterol. 2019;42–43:101610. Available from: http://dx.doi.org/10.1016/j.bpg.2019.04.003
  3. Amin SK, Antunes C. Lower Gastrointestinal Bleeding. In: SpringerReference. Springer-Verlag; Available from: http://dx.doi.org/10.1007/springerreference_108989
  4. Hreinsson JP, Gumundsson S, Kalaitzakis E, Björnsson ES. Lower gastrointestinal bleeding. Eur J Gastroenterol Hepatol. 2013;25(1):37–43. Available from: http://dx.doi.org/10.1097/meg.0b013e32835948e3
  5. Charilaou P, Devani K, Enjamuri D, Radadiya D, Reddy CM, Young M. Epidemiology of Lower GI Bleed in the United States - An Update From the National Inpatient Survey 2005-2014. Am J Gastroenterol. 2018;113(Supplement):S319. Available from: http://dx.doi.org/10.14309/00000434-201810001-00559
  6. Podugu A, Tandon K, Castro FJ. Crohn’s disease presenting as acute gastrointestinal hemorrhage. World J Gastroenterol. 2016;22(16):4073–8. Available from: https://pubmed.ncbi.nlm.nih.gov/27122659
  7. Lee M, Piao J, Jeon MJ. Risk Factors Associated with Endometrial Pathology in Premenopausal Breast Cancer Patients Treated with Tamoxifen. Yonsei Med J. 2020;61(4):317–22. Available from: https://pubmed.ncbi.nlm.nih.gov/32233174
  8. Kim E, Kang Y, Lee MJ, Park YN, Koh H. Life-threatening lower gastrointestinal hemorrhage in pediatric Crohn’s disease. Pediatr Gastroenterol Hepatol Nutr. 2013/03/31. 2013;16(1):53–60. Available from: https://pubmed.ncbi.nlm.nih.gov/24010107
  9. Kazama Y, Watanabe T, Akahane M, Yoshioka N, Ohtomo K, Nagawa H. Crohn’s disease with life-threatening hemorrhage from terminal ileum: successful control by superselective arterial embolization. J Gastroenterol. 2005;40(12):1155–7. Available from: http://dx.doi.org/10.1007/s00535-005-1714-9
  10. M’Koma AE. Inflammatory bowel disease: an expanding global health problem. Clin Med Insights Gastroenterol. 2013;6:33–47. Available from: https://pubmed.ncbi.nlm.nih.gov/24833941
  11. Adegboyega T, Rivadeneira D. Lower GI Bleeding: An Update on Incidences and Causes. Clin Colon Rectal Surg. 2019/11/11. 2020;33(1):28–34. Available from: https://pubmed.ncbi.nlm.nih.gov/31915423
  12. Laine L, Yang H, Chang S-C, Datto C. Trends for Incidence of Hospitalization and Death Due to GI Complications in the United States From 2001 to 2009. Am J Gastroenterol. 2012;107(8):1190–5. Available from: http://dx.doi.org/10.1038/ajg.2012.168
  13. Cotter TG, Buckley NS, Loftus CG. Approach to the Patient With Hematochezia. Mayo Clin Proc. 2017;92(5):797–804. Available from: http://dx.doi.org/10.1016/j.mayocp.2016.12.021
  14. Bai Y, Peng J, Gao J, Zou D-W, Li Z-S. Epidemiology of lower gastrointestinal bleeding in China: Single-center series and systematic analysis of Chinese literature with 53 951 patients. J Gastroenterol Hepatol. 2011;26(4):678–82. Available from: http://dx.doi.org/10.1111/j.1440-1746.2010.06586.x
  15. Pardi DS, Loftus E V, Tremaine WJ, Sandborn WJ, Alexander GL, Balm RK, et al. Acute major gastrointestinal hemorrhage in inflammatory bowel disease. Gastrointest Endosc. 1999;49(2):153–7. Available from: http://dx.doi.org/10.1016/s0016-5107(99)70479-7
  16. Daperno M, Sostegni R, Rocca R. Lower gastrointestinal bleeding in Crohn’s disease: How (un-)common is it and how to tackle it? Dig Liver Dis. 2012;44(9):721–2. Available from: http://dx.doi.org/10.1016/j.dld.2012.06.006
  17. Veauthier B, Hornecker JR. Crohn’s disease: diagnosis and management. Am Fam Physician. 2018;98(11):661–9.
  18. Petagna L, Antonelli A, Ganini C, Bellato V, Campanelli M, Divizia A, et al. Pathophysiology of Crohn’s disease inflammation and recurrence. Biol Direct. 2020;15(1):23. Available from: https://pubmed.ncbi.nlm.nih.gov/33160400
  19. Hovde Ø, Moum BA. Epidemiology and clinical course of Crohn’s disease: results from observational studies. World J Gastroenterol. 2012;18(15):1723–31. Available from: https://pubmed.ncbi.nlm.nih.gov/22553396
  20. Ng SC, Tang W, Ching JY, Wong M, Chow CM, Hui AJ, et al. Incidence and Phenotype of Inflammatory Bowel Disease Based on Results From the Asia-Pacific Crohn’s and Colitis Epidemiology Study. Gastroenterology. 2013;145(1):158-165.e2. Available from: http://dx.doi.org/10.1053/j.gastro.2013.04.007
  21. Ha F, Khalil H. Crohn’s disease: a clinical update. Therap Adv Gastroenterol. 2015;8(6):352–9. Available from: https://pubmed.ncbi.nlm.nih.gov/26557891
  22. Waugh N, Cummins E, Royle P, Kandala N-B, Shyangdan D, Arasaradnam R, et al. Faecal calprotectin testing for differentiating amongst inflammatory and non-inflammatory bowel diseases: systematic review and economic evaluation. Health Technol Assess. 2013;17(55):xv–211. Available from: https://pubmed.ncbi.nlm.nih.gov/24286461
  23. Lee JM, Lee K-M. Endoscopic Diagnosis and Differentiation of Inflammatory Bowel Disease. Clin Endosc. 2016/07/29. 2016;49(4):370–5. Available from: https://pubmed.ncbi.nlm.nih.gov/27484813
  24. Langner C, Magro F, Driessen A, Ensari A, Mantzaris GJ, Villanacci V, et al. The histopathological approach to inflammatory bowel disease: a practice guide. Virchows Arch. 2014; Available from: http://dx.doi.org/10.1007/s00428-014-1543-4
  25. Best WR, Becktel JM, Singleton JW, Kern F. Development of a Crohn’s Disease Activity Index. Gastroenterology. 1976;70(3):439–44. Available from: http://dx.doi.org/10.1016/s0016-5085(76)80163-1
  26. Lichtenstein GR, Loftus E V, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG Clinical Guideline: Management of Crohn’s Disease in Adults. Am J Gastroenterol. 2018;113(4):481–517. Available from: http://dx.doi.org/10.1038/ajg.2018.27

How to Cite

Paramita, D. N., Widodo, B., & Heriyawati, H. (2022). Profuse haematochezia related to Crohn’s disease: a rare case report. Bali Medical Journal, 11(1), 205–208. https://doi.org/10.15562/bmj.v11i1.3204

HTML
0

Total
0

Share

Search Panel

Dilly Niza Paramita
Google Scholar
Pubmed
BMJ Journal


Budi Widodo
Google Scholar
Pubmed
BMJ Journal


Heriyawati Heriyawati
Google Scholar
Pubmed
BMJ Journal