Hemoperitoneum following mild blunt abdominal trauma: First presentation of Crohn's disease

Abstract

Introduction: Inflammatory bowel diseases are heterogeneous in their presentation. Crohn's disease (CD) has been described as an unusual cause of massive lower gastrointestinal bleeding. We present a patient with CD whose first presentation was hemoperitoneum following mild blunt abdominal trauma Case presentation: A 54-year-old woman came to the emergency room with a blunt abdominal trauma. The patient underwent an abdominal CT scan with i.v. contrast medium injection, which showed hemoperitoneum with stenotic strictures of the small bowel and active massive bleeding from ileocolic artery. The rapid anemia onset and the CT report induced us to perform blood transfusion and an emergency exploratory laparotomy. Histological examination of the resected terminal ileum revealed a Crohn's disease. Discussion: Crohn's disease has been associated with hemoperitoneum, but to date there is no exact protocol regarding treatment of massive hemorrhagic Crohn's disease, which is rare. A conservative approach with medical therapy has been suggested for initial treatment. However, if medical treatment fails or bleeding continues even with intervention, bowel resection through surgical therapy should be performed.