Unusual clinical course
Yılmaz Baş, Güven Güney, Pınar Uzbay, Ethem Zobacı, Selin Ardalı, Ayşegül Taylan Özkan
Department of Pathology, Hitit University, Faculty of Medicine, Çorum, Turkey
Am J Case Rep 2015; 16:262-267
Available online: 2015-05-02
Behçet’s disease is a chronic inflammatory disease involving multiple systems, with vasculitis being the most important pathological feature. Multiple colon perforations are thought to be secondary to vasculitis and they occur in patients with ulcers. These may be encountered within the entire colon but most commonly in the ileocecal region. Intestinal perforation and Budd-Chiari syndrome are infrequent in Behçet’s disease, and are associated with high mortality and morbidity. Budd-Chiari syndrome results from occlusion of either hepatic veins or adjacent inferior vena cava, or both.
Case Report: We report a patient with Behçet’s disease having multiple perforations in the transverse colon, descending colon, and sigmoid colon. The patient also had Budd-Chiari syndrome due to inferior vena cava thrombosis extending into the right and middle hepatic vein. Our observations are presented with a review of the literature.
Conclusions: In Behçet’s disease, treatment of colon perforation necessitates urgent surgery, whereas management of Budd-Chiari syndrome is directed towards the underlying cause. Behçet’s disease, as a chronic multisystemic disease with various forms of vasculitis, is resistant to medical and surgical treatment. Prognosis is worse in Behçet’s disease with colon perforation than that in Budd-Chiari syndrome alone.
Keywords: Budd-Chiari Syndrome - diagnosis, Behcet Syndrome - diagnosis, Adult, Colectomy, Colonic Diseases - surgery, Colonoscopy, Diagnosis, Differential, Intestinal Perforation - surgery, Rupture, Spontaneous, Tomography, X-Ray Computed