Massive Bleeding

Massive bleeding from the large intestine that requires immediate surgical treatment is very rare in Crohn's disease. It affects 1.3-1.9% of all patients [91, 95], and 12% of all cases of bleeding from a digestive tract in patients with Crohn's disease [96]. Massive bleeding occurs in states of severe exacerbations, or a severe form of the disease such as toxic/fulminant colitis. It is necessary to locate the site of massive bleeding because as opposed to ulcerative colitis, its location is well defined. The site of bleeding in most cases in the affected part of the intestine is most frequently the ulceration in the left part of colon [97]. Identification of the bleeding site may be done with the use of colonoscopy; at the time of the procedure, the surgeon may attempt to stop bleeding using endoscopic methods. If the bleeding site has not been identified with the use of colonoscopy, lower mesen-teric artery angiography should be considered. It is also necessary to execute the endoscopy of the upper digestive tract in order to exclude the bleeding from that part. Similar to other types of gastrointestinal bleeding, the first line of treatment is a conservative therapy consisting of anti-haemorrhagic drugs as well as blood and plasma transfusions. An example of a successful treatment of the bleeding ileocolic anastomosis with infliximab transfusion can be found in the literature [98].

Massive bleeding resistant to conservative treatment or lacking in the possibility of such treatment, recurring bleeding that follows previous conservative treatment, as well as other clinical reasons may be considered to be an indication for surgical treatment. A colectomy with ileostomy is to be performed if pathological changes affect the rectum, and a colec-tomy with ileo-rectal anastomosis is to be performed if the rectum is free of pathological changes [91].

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