Colitis in Behçet's disease: Characteristics on double-contrast barium enema examination in 20 patients

Abstract

We performed a retrospective review of double-contrast barium enema examinations of 20 patients with clinically proven Behçet's colitis. Main lesion was ovoid or geographic ulcers with a mean diameter of 2.7 cm. The number of ulcers was single in 15 cases and multiple in five. On six resected specimens, ulcers involved submucosa in three, muscle layer in one, and serosa in two cases with an undermining tendency and transmural inflammation. Aphthous ulcers were present in three cases. Neither perforation nor fistula was demonstrated. In all 20 patients, the ulcer was localized in the ileocecal area, with extension to the ascending colon in seven. Skip lesions were observed in the transverse colon and descending colon in three cases. Destruction of surrounding mucosa resulted in cecal contraction in 19 cases, widening of the ileocecal valve in 19, and fold thickening in the terminal ileum in 12. Six cases (30%) manifested as ileocecal mass accompanied by ulcer, fold thickening, and adjacent mucosal deformity. The appendix was visualized in only three (20%) of the 15 patients with no history of appendectomy. On follow-up study of 15 cases, the ulcers disappeared or decreased in size in 13 cases (86%) and the mucosal deformity was not improved in all cases. On the basis of our results, we believe that the characteristic findings of colitis in Behçet's disease in barium enema examination are ovoid or geographic, relatively large, and deep ulcerations with persistent surrounding deformity which tend to localize in the ileocecal area.

Gastrointestinal Manifestations of Behçet’s Disease

“…Complete remission was achieved in 38% of patients with intestinal BD after 8 weeks of medical treatment [41]. The rate of recurrence after surgery has been reported to be 40-56% [18,47]. Recurrence occurred in 49% of patients at 5 years, especially those with intestinal perforation or fistula formation [41].…”

“…The average length of involved bowel was 6.4 cm in one report. A nonspecific pattern of small bowel malabsorption can be seen [46] as can cecal contraction, widening of the ileocecal valve, fold thickening in the terminal ileum, and an apparent ileocecal mass with ulceration [47]. Enteroclysis showed pathology in 71% of patients that did not correlate with disease duration [48].…”

Imaging Features of Behçet’s Disease

“…They are mostly an inflammatory thickening affecting intestinal anastomoses where new ulcerations may appear. These have a tendency to result in perforations (Kim et al 1994;Lida et al 1994). …”

“…Double-contrast barium enema is more sensitive than single-contrast in detecting small-sized ulcerations (Fig. 34) (Kim et al 1994;Ha et al 1998). …”

Skip colonic ulceration in typhoid ileo-colitis

“…Inflammation was more severe in the appendix than in the cecum. Secondly, Kim et al 3 found that 15% of patients with Behcet's colitis had skip lesions. The main ulcers were located in the ileocecal region, while the skip lesions were observed in the transverse colon and descending colon.…”