Repeated massive lower intestinal bleeding in Crohn's disease: Successful control by endoscopic therapy

In Crohn's disease, characterized by longitudinal ulcers and a cobblestone appearance of the intestinal mucosa, massive lower intestinal bleeding requiring blood transfusions to maintain normal vital signs is a relatively rare complication (1-3% of all cases). Although surgery may be the most appropriate treatment for such massive bleeding, recurrent hemorrhage is occasionally encountered. We describe a 23-year-old male patient with Crohn's disease who suffered massive bleeding three times within a two-year period, and successful hemostasis was obtained by endoscopic local injection of hypertonic saline epinephrine (HSE) and clipping on each occasion. It is rare for episodes of massive lower intestinal bleeding in Crohn's disease to be repeated over a relatively short period. In the present patient, emergency colonoscopy was diagnostically helpful, and the bleeding was successfully controlled by endoscopic therapy. Thus, endoscopic therapy should be used conservatively in Crohn's disease with recurrent major hemorrhage to avoid multiple abdominal surgery.