Spontaneous Intra-Abdominal Hemorrhage Due to Rupture of Jejunal Artery Aneurysm in Behcet Disease

Abstract

Rupture of jejunal artery aneurysm is a very rare event resulting in life-threatening hemorrhage in Behcet disease (BD). We report a case of ruptured jejunal artery aneurysm in a 35-year-old patient with BD. The patient had a 1-year history of intermittent abdominal pain caused by superior mesenteric artery aneurysm with thrombosis. Anticoagulation treatment showed a good response. Past surgical history included stenting for aortic pseudoaneurysm. On admission, the patient underwent an urgent operation due to sudden hemorrhagic shock. Resection was performed for jejunal artery aneurysm and partial ischemia of intestine. The patient was diagnosed with BD, based on a history of recurrent oral and skin lesions over the past 6 years. Treatment with anti-inflammatory medications showed a good response during the 8-month follow-up.An increased awareness of BD and its vascular complications is essential. Aneurysms in BD involving jejunal artery are rare, neglected and require proper management to prevent rupture and death. To our knowledge, this is the first reported case of jejunal artery aneurysm caused by BD.

Superior Mesenteric Artery Vasculitis in Behçet's Disease: A Case Report and Literature Review

“…The complete type of BD was seen in one case (13). Three patients had ocular lesions (12,13,26), five had genital aphthosis (13-17), 11 had oral ulcers (12-18,21,24-26), and five had skin lesions (13,15,16,24,26). There were no articles reporting neurological findings in a patient with BD.…”

“…The treatment and clinical outcome data from patients diagnosed with vasuculo-BD are summarizes in Table 3. Six patients were first diagnosed with BD at the time of the onset of vasculo-BD (13-15,17,24,25). The duration of the period from the diagnosis of BD to the onset of vasculo-BD in the SMA was 2-15 years (12,16,18-20,22,23).…”

Vascular Manifestations of Behçet’s Disease

“…This is followed in frequency by the pulmonary, femoral, subclavian, and common carotid arteries [46]. Although rare, we may encounter visceral artery involvement such as in jejunal arteries as reported by Wu et al [61].…”

“…Surgery or endovascular treatment used without immunosuppressive medical therapy increases the risk of development of complications and pseudoaneurysm after the operation or intervention [61]. Because of this important fact, endovascular or surgical treatment must be combined with medical therapy.…”

“…There is no proof supporting the use of anticoagulants in the treatment of arterial lesions. Anticoagulant use is not advised [61]. Nevertheless, the use of anticoagulants or antiaggregants in combination with immunosuppressive and antiinflammatory agents in order to prevent graft occlusions in the postoperative period may be useful [60].…”