The study of the local immunity in Helicobacter pylori-infective gastric mucosa

Abstract

A 32 year old white male with an eight year medical history of Crohn's disease but no surgical history came to the ER after fainting in the shower. He complained of light headedness and multiple black tarry stools that had gradually progressed to bright red, bloody diarrhea over the course of four days. There were no accompanying abdominal cramps, nausea, vomitting or hemetemesis. While in house patient continued to bleed requiring a total of ten units of blood. Patient underwent EGD which showed candidiasis and no active bleeding. Colonoscopy was performed in which terminal ileum was entered and biopsies taken. It only showed melenic stools and no active bleeding. Biopsy from terminal ileum suggested Crohn's disease. Patient continued to drop his H&H and RBC-tagged bleeding scan was done which showed bleeding in the right mid-upper abdomen. Patient underwent angiography of the superior mesenteric artery with urokinase challenge that led to identification of brisk bleeding from an arterial branch to the mid ileum. Patient was taken into surgery and bleeding site was identified with methylane blue injection through the angiography catheter. Fifteen centimeters of the diseased terminal ileum was resected sparing the last five centimeters and the ileal cecal valve. Post-operative recovery went well and the patient was discharged on post-operative day number six. Conclusion: Massive bleeding from the ileum is extremely rare in purely ileal Crohn's disease. Only about I% to 2% of patients with Crohn's bleed so massively and those usually have some colonic involvement. This case is unusual in the very fact that such heavy ileal bleeding occurred when this is a complication more commonly associated with colonic Crohn's.