title: A case of Crohn's disease with recurrent massive life-threatening hemorrhage from terminal ileum.
abstract: A case of Crohn's disease that underwent bowel resection two times at 3-year intervals due to life-threatening hemorrhage from ileum is presented. The bleeding sites were located in the ulcer lesions of ileum, in the oral side near to the ileum-colon transition. The first bleeding point was at the longitudinal ulcer of the terminal ileum and the secondary bleeding site was at the profound ulcer of ileum appearing in the oral side near to the ileo-colic anastomosis. This is the first case of Crohn's disease with recurrent life-threatening massive hemorrhage in the terminal region of ileum, for which operative bowel resections were necessary. This case suggests that we should search for the bleeding site in ileal lesions developed in the circumference of and especially the oral side near to the anastomosis due to prior resection, when intestinal massive bleeding occurs again after bowel resection, and that the careful follow-up and strict treatment with diet therapy and/or anti-inflammatory drugs are necessary for the protection of recurrence in patients with Crohn's disease.
authors.affiliation: Department of Medicine III, Osaka University Medical School, Suita City, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Egawa
authors.forename: T
authors.initials: T
authors.lastname: Kuroda
authors.forename: H
authors.initials: H
authors.lastname: Ogawa
authors.forename: A
authors.initials: A
authors.lastname: Takeda
authors.forename: S
authors.initials: S
authors.lastname: Kanazawa
authors.forename: H
authors.initials: H
authors.lastname: Harada
authors.forename: N
authors.initials: N
authors.lastname: Tomita
authors.forename: T
authors.initials: T
authors.lastname: Shimano
authors.forename: H
authors.initials: H
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D003424:Crohn Disease / Q000473:pathology / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007077:Ileal Diseases / Q000473:pathology / Q000601:surgery*; D007082:Ileum / Q000473:pathology / Q000601:surgery; D008297:Male; D012008:Recurrence; D012086:Reoperation; D014456:Ulcer / Q000473:pathology / Q000601:surgery*