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The Turkish Journal of Gastroenterology
2010, Volume 21, No 3, Page(s) 324-325
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LETTERS TO THE EDITOR
A case of Behçet’s disease with multiple colon perforations
Serdar KURU, Arif Hakan DEMİREL, Mustafa DÖNMEZ
Department of Surgery, Ministry of Health, Ankara Research and Training Hospital, Ankara
Introduction
To the Editor,

A 20-year-old male patient presented to the Emergency Department with complaints of abdominal pain and fever. An air-fluid level was present below the right diaphragm. Extensive fibrous adhesions, localized abscesses, a 2x3 cm perforation on the tenia of the cecum, and two 2x2 cm perforations on the transverse colon were observed on the laparotomy (Figure 1). Extended right hemicolectomy and ileostomy were performed. Histopathological diagnosis was reported as ischemic colitis and hemorrhagic infarction. On ophthalmology consultation, sequelae of vitreous cells were evaluated in favor of uveitis. The patient also had a history of recurrent oral aphthae for four years and moderate congenital bilateral hearing loss, which was confirmed by audiogram. A treatment protocol consisting of Colchicum-dispert (colchicine), interferonalpha, and salicylate for 20 days was initiated in the postoperative second week. He was followed on interferon treatment for six months, and then interferon was administered one day/week for three months. The ileostomy was closed in the postoperative third month. The patient is now in remission at the 24th month following the first operation and his medical treatment continues.

Behçet’s disease is characterized by recurrent oral and genital ulcers, together with ocular and skin lesions. In addition, gastrointestinal, respiratory, vascular, and neurological symptoms have been described (1). The essential pathology in gastrointestinal Behçet’s disease is vasculitis and inflammation, with primary involvement of the venules. While onset in Behçet’s disease is most frequently seen around the age of 30 years, gastrointestinal involvement generally occurs at approximately 40 years of age (2). The initial age of disease in this case and the timing of colon perforation were both significantly below the associated mean ages reported in the literature.

A special feature of the form of Behçet’s disease involving the gastrointestinal system is a course of recurrences and remissions (2). Acute and chronic inflammation, pseudopolyp formation, linear ulcers, and crypt abscesses may be observed in the colon. Intestinal perforations often occur freely, and are generally multiple with a tendency to recur (1). An important feature of the case presented in this article is that the patient presented with colonic perforation during the first acute attack.

The treatment of Behçet’s disease has not yet been established completely. The necessity of medical treatment is to relieve the symptoms, lessen the inflammation and prevent the recurrences. According to the authors, combined therapy has been suggested for the best recovery (3, 4).

In conclusion, although it is rare, consideration of Behçet’s disease will facilitate the diagnostic evaluation in cases presenting with distal ileum and colonic perforations. Our treatment standard is characterized by a team approach including a general surgeon, rheumatologist, immunologist, ophthalmologist, and a dermatologist.
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  • Introduction
  • References
  • References
    1. Melikoglu M. Behcet hastal›gi. In: Iliçin G, Bibero¤lu K, Suleymanlar G, Unal S, eds. Ic hastaliklari. 2. bask›. Ankara: Gunes Kitapevi, 2003; 2773-9.

    2. Sayek I. Entero-Behçet hastal›g›. In: Sayek I, ed. Temel cerrahi. 3. baski. Ankara: Gunes Kitapevi, 2004; 1219-21.

    3. Byeon JS, Choi EK, Heo NY, et al. Antitumor necrosis factor-alpha therapy for early postoperative recurrence of gastrointestinal Behçet's disease: report of a case. Dis Colon Rectum 2007; 50: 672-6.

    4. Tugal-Tutkun I, Guney-Tefekli E, Urgancioglu M. Results of interferon-alfa therapy in patients with Behçet uveitis. Graefes Arch Clin Exp Ophthalmol 2006; 244: 1692-5.

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