As CD patients typically already have multiple sites of mural abnormalities accompanied by hyperenhancement (a common finding of CD inflammation), it is impossible to know whether any such abnormalities are a source of bleeding unless one directly sees bleeding at the time of CT scan. Unlike in other causes of LGIB, for which CT detection of a potential source of bleeding (such as an abnormal vasculature/hyperenhancement or a tumor) instead of direct visualization of bleeding is essentially diagnostic, a direct demonstration of contrast extravasation is generally needed for CT to determine the site of LGIB in CD. However, it has rarely been addressed, if the same recommendation applies to CD patients with LGIB, for whom the presence of CD poses unique difficulties to the CT evaluation. When ileocolonoscopy fails to reveal the bleeding focus, the small bowel is difficult or even impossible to access with video capsule endoscopy or deep enteroscopy in the presence of bowel strictures ( 10, 11).Д¬ontrast-enhanced abdominopelvic computed tomography (CT), either routine CT or CT enterography (CTE), is generally recommended in patients with LGIB ( 11, 12).

It is often difficult to determine the precise site of bleeding unless active bleeding is directly observed during the examination owing to the presence of multiple areas of inflammation ( 5, 8). Diagnostic evaluation of LGIB in CD patients is challenging because of several factors. Moreover, the risk of later rebleeding is fairly high, ranging from 19% to 41% according to the literature ( 1, 2, 5, 8, 9). Acute severe lower gastrointestinal bleeding (LGIB) is an uncommon but potentially life-threatening complication of Crohn's disease (CD), with reported incidence ranging from 0.6% to 6% ( 1, 2, 3, 4, 5, 6, 7, 8).

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