Regional enteritis with major gastrointestinal hemorrhage as the initial manifestation.

Four patients with massive gastrointestinal hemorrhage were found to have Crohn's ileitis. This prompted a five-year chart review of consecutive admissions for Crohn's enteritis; 60 patients were found whose disease was limited to the distal part of the ileum (and rarely the proximal part of the cecum). Eight (13%) of these patients were admitted because of major rectal bleeding, and in seven of the eight the hemorrhage was the initial manifestation of Crohn's disease. The mean age of the entire group was 30 years, with a mean age of 18.6 years in the eight bleeders. Crohn's ileitis should be considered in the differential diagnosis of massive rectal bleeding, especially in younger patients.