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Crohn disease - actively bleeding ileal disease

Case contributed by Dr Chris O'Donnell

Presentation

Known Crohn disease. Now bright PR bleeding with drop of Hb by 20 units and hypotension to 70mmHg systolic.

Patient Data

Age: 45 years
Gender: Male

Circumferential thickening of the distal ileum with a small focus of contrast extravasation in the terminal ileum ~ 8-10cm from the ileo-cecal junction that pools on the PV phase.  Note also on the PV phase that all the muscosa of the distal ileum enhances markedly indicating active inflammation.  Note also hyperdense bowel content in the distal ileum and colon including the rectum indicative of fresh blood.

Case Discussion

Bloody diarrhea is a hallmark of active Crohn disease but frank bright blood PR is unusual, and the finding of active contrast extravasation on CT mesenteric angiography even more so.  The detection of marked mucosal enhancement (indicating inflammation) on CT is also unusual to this degree.

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