Background The aneurysms of the celiac trunk are the rarest aneurysms of the visceral arteries. Spontaneous celiac trunk aneurysm has not been described previously in Behcet’s disease.
Objectives A 19-yr-old Turkish man was admitted to our hospital with a history of abdominal pain for 2 weeks. He described recurrent attacks of ulcerations of the oral and genital mucosa, blurred vision and painful lesions on the front of the legs for 2 years. He had had abdominal pain for 6 months, but this symptom had become more troublesome in the last 2 weeks. Physical examination revealed no pathology except for mild abdominal tenderness and deeply pigmented areas on the front of the legs. Ophthalmologic examination showed ocular inflammation and retinal vasculitis. Laboratory evaluations revealed haemoglobin of 14.4 g/dl, white blood cell count of 9650 cells/mm and platelet count of 470000 cells/mm. The erythrocyte sedimentation rate was 61 mm/h, C-reactive protein 11.5 mg/l (normal <0.8 mg/l), and fibrinogen 422 mg/dl (normal: 200–400 mg/dl for male). HLA-B51 is positive. Pathergy test is positive. Celiac trunk aneurysm was detected by computed tomography. A selective angiogram showed dilatation of the celiac artery and an aneurysm with a diameter 4´2 cm.
Methods Visceral artery aneurysm is a rare, but important form of vascular pathology. Aneurysms of splenic artery are the most common. Aneurysms of the celiac artery are uncommon and account for 4% of all splanchnic aneurysms. They can rupture in 2–50% of the cases with a mortality rate of around 80%. The most common etiologic factor of celiac artery aneurysms is atherosclerosis; other causes include infection, trauma, polyarteritis nodosa and fibromuscular dysplasia.
Behcet’s disease is an uncommon multisystemic inflammatory disorder characterised by recurrent oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. Involvement of the large vessels is less frequent. Vascular involvement in Behcet’s disease is divided into venous and arterial thrombosis and arterial aneurysmal formation. Arterial involvement of Behcet’s disease most frequently affects the abdominal aorta, followed by the femoral and the pulmonary arteries.
Results In this case, he fulfils the described criteria for Behcet’s disease by the International Study Group for Behcet’s disease in 1990. Our diagnosis of Behcet’s disease was based mainly on the recurrent oral ulceration, recurrent genital ulceration, eye lesion, skin lesion, and positive HLA-B51 and pathergy test.
Conclusion To our knowledge, the present case is the first patient described with Behcet disease who developed celiac trunk aneurysms. We should be aware of this complication in patients with Behcet’s disease who develop abdominal pain.
Junewick JJ, Grant TH, Weiss CA, et al. Celiac artery aneurysm: color Doppler evaluation. J Ultrasound Med. 1993;12:355
Sakane T, Takeno M, Suzuki N, Inaba G. Behcet’s disease. N Engl J Med. 1999;341(17):1284–91
Vohra R, Carr HMH, Welch M, et al. Management of celiac artery aneurysms. Br J Surg. 1991;78:1373
Lukes P, Wihed A, Tidebrant G, et al. Angiography of visceral aneurysms. Eur Radiol. 1994;4:75
International Study Group for Behcet’s Disease. Criteria for diagnosis of Behcet’s disease. Lancet 1990;335:1078–80
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.