Mehmet BEKTAŞ, Çağdaş KALKAN, İrfan SOYKAN, Ayşe BOYVAT, Berna SAVAŞ, Ethem GEÇİM, Onur KESKİN, Ekin KIRCALİ, Ali TÜZÜN, Necati ÖRMECİ

8428

Behçet’lilerde ileokolonik perforasyon riski: Üç olgu sunumu ve literatürün gözden geçirilmesi

Giriş ve Amaç:İntestinal Behçet Hastalığı ciddi komplikasyonlara neden olabilir. Masif kanama, fistülizasyon ve intestinal perforasyon, intestinal Behçet Hastalığı olanların yaklaşık %50’sinde rastlanan komplikasyonlardır. İntestinal Behçet tanısı alanlarda, kolonoskopi sırasındaki iatrojenik ileokolonik perforasyonu inceleyen yeterli çalışma ve data yoktur. Bu nedenle biz intestinal Behçet Hastalığı olanlarda kolonoskopi sırasında ve kolonoskopi sonrasında gelişen perforasyon sorununu incelemeyi amaçladık. Gereç ve Yöntem:Mayıs 2002 ile Aralık 2007 tarihleri arasında üniversitemizde yapılan 2615 kolonoskopi olgusu değerlendirildi. Bu 2615 olgunun 135’inin kolonoskopi için ana endikasyonu intestinal Behçet Hastalığı idi. Bulgular: Toplam 135 intestinal Behçet hastasında ileokolonik tutulum olup olmadı-ğını anlamak için kolonoskopi yapıldı. 135 hastanın 8’inde (%5,9) ileal ve kolonik ülserler saptandı. İatrojenik perforasyon üç olguda (%2,22) görülürken, bunların 2’sinde proksimal kolon ve ileum’da ülserler bulundu. Üçüncü olgunun ülserleri sigmoid kolon, inen ve transvers kolon segmentlerindeydi. Bu 3 olgunun hepsi de ileal rezekziyon ve sağ hemikolektomi için cerrahiye gönderildiler. Sonuç:Behçet Hastalığında yalnız tanı için değil, aynı zamanda Behçet Hastalığının intestinal tutulumunun sürveyansı için kolonoskopi muayenesi çok yaygın olarak kullanılır. Volkan biçimli ülserler perforasyona özellikle eğilimlidirler. Konoskopi sırasında aşırı hava verilmesi perforasyona sebep olabileceğinden klinisyenler ve endoskopistler bu konuda uyanık olmalıdır. Ayrıca hastalar; kolonoskopik inceleme sonrasında karın ağrısı durumunda mutlaka takip edilmeli ve kolonik perforasyon her zaman akılda tutulmalıdır.
Anahtar Kelimeler:

Behçet hastalığı, kolonoskopi, ileokolonik perforasyon

The risk of ileocolonic perforation in patients with Behçet’s Disease: A Report of three cases and a review of the literature

Background and Aims:Intestinal Behcet’s disease may cause serious complications, including massive hemorrhage, fistulisation and intestinal perforation, which are encountered in approximately 50% of patients. Currently, there is little data on iatrogenic ileocolonic perforation during colonoscopy in patients with intestinal Behcet’s disease; therefore, our aim is to perform a retrospective review of records of intestinal Behcet’s disease patients who suffered perforation during or after colonoscopy. Materials and Methods: A total of 2615 colonoscopic examinations were performed between May 2002 and December 2007. The main indication for colonoscopy was intestinal Behcet’s disease in 135 of the 2615 patients. Results:135 patients with Behcet’s disease were evaluated by colonoscopy due to presumed ileocolonic involvement. Eight out of 135 (5.9%) patients had ileal and colonic ulcers. 3 patients (2.22%) had iatrogenic perforation; 2 of whom had profound ulcers in proximal colon and ileum. The third case had ulcers in the sigmoid, descending and transverse colon segments. All 3 patients had undergone surgical intervention that included ileal resection and right hemicolectomy. Conclusion:Colonoscopic examination is commonly used in Behcet’s disease not only for diagnostic purposes but also for surveillance of intestinal involvement. Volcano-shaped ulcers are especially prone to perforate. Both clinicians and endoscopists should be alert against barotrauma during colonoscopy since it may cause perforation. Patients should also be followed, and in case of abdominal pain after colonoscopic examination, colonic perforation should be considered.
Keywords:

Behcet’s disease, colonoscopy, ileocolonic perforation,

PDF

___

  • 1. Behcet H. Über rezidivierende aphthose, durch ein virus verursachte geschwure am mund, am auge und an den genitalien. Dermatologische Wochenschrift 1937;105:1152-7.
  • 2. Kobayashi K, Ueno F, Bito S, et al. Development of consensus statements for the diagnosis and management of intestinal Behcet’s disease using a modified Delphi approach. J Gastroenterol 2007;42:737-45.
  • 3. Sakane T, Takeno M, Suzuki N, Inaba G. Behcet’s disease. N Engl J Med 1999;341:1284-91.
  • 4. al-Aboosi MM, al Salem M, Saadeh A, et al. Behcet’s disease: clinical study of Jordanian patients. Int J Dermatol 1996;35:623-5.
  • 5. Al-Otaibi LM, Porter SR, Poate TW. Behcet’s disease: a review. J Dent Res 2005;84:209-22.
  • 6. Jankowski J, Crombie I, Jankowski R. Behcet’s syndrome in Scotland. Postgrad Med J 1992;68:566-70.
  • 7. Shimizu T, Ehrlich GE, Inaba G, Hayashi K. Behcet disease (Behcet syndrome). Semin Arthritis Rheum. 1979;8:223-60
  • 8. Chen YC, Chang HW. Clinical characteristics of Behcet’s disease in southern Taiwan. J Microbiol Immunol Infect 2001;34:207-10.
  • 9. Tunc R, Keyman E, Melikoglu M, et al. Target organ associations in Turkish patients with Behcet’s disease: a cross sectional study by exploratory factor analysis. J Rheumatol 2002;29:2393-6.
  • 10. al-Dalaan AN, al Balaa SR, el Ramahi K, et al. Behcet’s disease in Saudi Arabia. J Rheumatol 1994; 21:658-61.
  • 11. Barnes CG. Treatment of Behcet’s syndrome. Rheumatology (Oxford) 2006;45:245-7.
  • 12. Bayraktar Y, Ozaslan E, Van Thiel DH. Gastrointestinal manifestation of Behçet’s disease. J Clin Gastroenterol 2000;30:144-54.
  • 13. Takada Y, Fujita Y, Igarashi M, et al. Intestinal Behcet’s disease-pathognomonic changes in intramucosal lymphoid tissues and effect of a ‘‘rest cure’’ on intestinal lesions. J Gastroenterol 1997;32:598-604.
  • 14. Kasahara Y, Tanaka S, Nishino M, el al. Intestinal involvement in Behcet’s disease: review of 136 surgical cases in the Japanese literature. Dis Colon Rectum 1981;24:103-6.
  • 15. Baba S, Maruta M, Ando K, et al. Intestinal Behcet’s disease: report of five cases. Dis Colon Rectum 1976;19:428-40.
  • 16. Ketch LL, Buerk CA, Liechty D. Surgical implications of Behcet’s disease. Arch Surg 1980;115:759-60.
  • 17. Smith JA, Siddiqui D. Intestinal Behcet’s disease presenting as a massive acute lower gastrointestinal bleed. Dig Dis Sci 2002;47:517-21.
  • 18. Sayek I, Aran O, Uzunalimoglu B, Hersek E. Intestinal Behcet’s disease: surgical experience in seven cases. Hepatogastroenterology 1991;38:81-3.
  • 19. Oshima Y, Shimizu T, Yokohari R, et al. Clinical studies on Behcet’s syndrome. Ann Rheum Dis 1963;22:36-45.
  • 20. Köklü S, Yüksel O, Onur I, et al. Ileocolonic involvement in Behçet’s Disease: Endoscopic and histological evaluation. Digestion 2010;81:214-7.
  • 21. Bradbury AW, Milne AA, Murie JA. Surgical aspects of Behcet’s disease. Br J Surg 1994;81:1712-21.
  • 22. Wullstein Ch, Ko¨ ppen MO, Gross E. Laparoscopic treatment of colonic perforations related to colonoscopy. Surg Endosc 1999;13:484-7.
  • 23. Young HS, Keeffe EB. Complications of gastrointestinal endoscopy. In: Sleisenger & Fordtran’s. Gastrointestinal and Liver Diseases. 6th ed. Philadelphia: WB Saunders, 1998;301-9.
  • 24. Orsoni P, Berdah S, Verrier C, et al. Colonic perforation due to colonoscopy: a retrospective study of 48 cases. Endoscopy 1997;29:160-4.
  • 25. International Study Group for Behcet’s Disease. Criteria for diagnosis of Behcet’s disease. Lancet 1990;335:1078-80.
  • 26. Brodie TE, Ochsner JL. Behcet’s syndrome with ulcerative esophagitis: Report of the first case. Thorax 1973;28:637-40.
  • 27. Gamble CN, Wiesner KB, Shapiro RF, Boyer WJ. The immune complex pathogenesis of glomerulo-nephritis and pulmonary vasculitis in Behcet’s disease. Am J Med 1979;66;1031-9.
  • 28. Bechgaard P. Et tilfaelds af recidiverende aphtøs stomatitis ledsaget af conjunctivitis og ulcerationer paa genitalia oghud. Ugeskr Laeger 1940;102:1019-23.
  • 29. Korman U, Cantasdemir M, Kurugoglu S, et al. Enteroclysis findings of intestinal Behcet disease: a comparative study with Crohn’s disease. Abdom Imaging 2003;28:308-12.
  • 30. Lee CR, Kim WH, Cho YS, et al. Colonoscopic findings in intestinal Behcet’s disease. Inflamm Bowel Dis 2001;7:243-9.
  • 31. Chou SJ, ChenVT, Jan HC, et al. Intestinal perforations in Behcet’s disease. J Gastrointest Surg 2007;11:508-14.
  • 32. Lee SK, Kim BK, Kim TI, Kim WH. Differential diagnosis of intestinal Behcet’s disease and Crohn’s disease by colonoscopic findings. Endoscopy 2009;41:9-16.
  • 33. Kim JS, Lim SH, Choi IJ, et al. Prediction of the clinical course of Behçet’s colitis according to macroscopic classification by colonoscopy. Endoscopy 2000;32:635-40.
  • 34. Greenstein AJ, Mann D, Sachar DB, Aufses AH Jr. Free perforation in Crohn’s disease: I. A survey of 99 cases. Am J Gastroenterol 1985;80:682-9.
  • 35. Greenstein AJ, Sachar DB, Mann D, , et al. Spontaneous free perforation and perforated abscess in 30 patients with Crohn’s disease. Ann Surg 1987;205:72-6.
  • 36. Katz S, Schulman N, Levin L. Free perforation in Crohn’s disease: a report of 33 cases and review of literature. Am J Gastroenterol 1986;81:38-43.
  • 37. Turan M, Sen M, Koyuncu A, et al. Sigmoid colon perforation as an unusual complication of Behcet’s syndrome: report of a case. Surg Today 2003;33:383-6.
  • 38. Moon CM, Cheon JH, Shin JK, et al. Prediction of free bowel perforation in patients with intestinal Behçet’s disease using clinical and colonoscopic findings. Dig Dis Sci 2010;55:2904-11.
  • 39. Toynton SC. Behcet’s syndrome: an unusual cause of ileal perforation. J Clin Gastroenterol 1994;19:84-5.
  • 40. Isik B, Ara C, Kirimlioglu H, et al. Single or multiple perforations with varying locations as a complication of intestinal Behcet’s disease: report of three cases. Scand J Gastroenterol 2005;40:599-603.
  • 41. Iida M, Kobayashi H, Matsumoto T, et al. Postoperative recurrence in patients with intestinal Behcet’s disease. Dis Colon Rectum 1994;37:16-21.
  • 42. Choi IJ, Kim JS, Cha SD, et al. Long-term clinical course and prognostic factors in intestinal Behcet’s disease. Dis Colon Rectum 2000;43:692-700.
  • 43. Lee KS, Kim SJ, Lee BC, et al. Surgical treatment of intestinal Behcet’s disease. Yonsei Med J 1997;38:455-60.
  • 44. Naganuma M, Iwao Y, Inoue N, et al. Analysis of clinical course and long-term prognosis of surgical and nonsurgical patients with intestinal Behçet’s disease. Am J Gastroenterol 2000;95:2848-51.
  • 45. Toda K, Shiratori Y, Yasuda M, et al. Therapeutic effect of intraarterial prednisolone injection in severe intestinal Behçet’s disease. J Gastroenterol 2002;37:844-8.
  • 46. Beales IL. Gastrointestinal involvement in Behçet’s syndrome. Am J Gastroenterol 1998;93:2633.
  • 47. Hassard PV, Binder SW, Nelson V, Vasiliauskas EA. Antitumor necrosis factor monoclonal antibody therapy for gastrointestinal Behçet’s disease: a case report. Gastroenterology 2001;120:995-9.
  • 48. Anderson ML, Pasha TM, Leighton JA. Enodoscopic perforation of the colon: lesson from a 10-year study. Am J Gastroenterol 2000;95:3418-22.
  • 49. Carpio G, Albu E, Gumbs MA, Gerst PH. Management of colonic perforation after colonoscopy: report of three cases. Dis Colon Rectum 1989;32:624-6.
  • 50. Garbay JR, Suc B, Rotman N, et al. Multicentre study of surgical complications of colonoscopy. Br J Surg 1996;83:42-4.
  • 51. Jentchura D, Raute M, Winter J, et al. Complications in endoscopy of the lower gastrointestinal tract: therapy and prognosis. Surg Endosc 1994;8:672-6.
  • 52. Hunt RH. Towards safer colonoscopy. Gut 1983;24:371-5.
  • 53. Macrae FA, Tan KG, Williams CB. Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies. Gut 1983;24:376-83.
  • 54. Farley DR, Bannon MP, Zietlow SP, et al. Management of colonoscopic perforations. Mayo Clin Proc 1997;72:729-33.
  • 55. Hall C, Dorricott NJ, Donovan IA, Neoptolemos JP. Colon perforation during colonoscopy: surgical versus conservative management. Br J Surg 1991;78:542-4.
  • 56. Dafnis G, Ekbom A, Pahlman L, Blomqvist P. Complications of diagnostic and therapeutic colonoscopy within a defined population in Sweden. Gastrointest Endosc 2001;54:302-9.
  • 57. Damore LJ 2nd, Rantis PC, Vernava AM 3rd, Longo WE. Colonoscopic perforations. Etiology, diagnosis, and management. Dis Colon Rectum 1996;39:1308-14.
Endoskopi Gastrointestinal-Cover
  • ISSN: 1302-5422
  • Başlangıç: 2010
  • Yayıncı: Türk Gastroenteroloji Vakfı
Arşiv
Sayıdaki Diğer Makaleler

Alt gastrointestinal sistem endoskopisi: 1800 olgunun retrospektif analizi ve kolorektal kanser sıklığının belirlenmesi

Yusuf YÜCEL, Alpay AKTÜMEN, Timuçin AYDOĞAN, Ahmet UYANIKOĞLU, Ahmet ŞEKER, Orhan GÖZENELİ, Abdullah ÖZGÖNÜL, Alpaslan TERZİ, Ali UZUNKÖY

Behçet’lilerde ileokolonik perforasyon riski: Üç olgu sunumu ve literatürün gözden geçirilmesi

Mehmet BEKTAŞ, Çağdaş KALKAN, İrfan SOYKAN, Ayşe BOYVAT, Berna SAVAŞ, Ethem GEÇİM, Onur KESKİN, Ekin KIRCALİ, Ali TÜZÜN, Necati ÖRMECİ

Sitomegalovirüse bağlı gastritis; Olgu sunumu.

A WOOLS, Halil AKOL

Hemoklips ile endoskopik tedaviye rağmen devam eden duodenal ülser kanaması olan bir hastada “Ankaferd Blood Stopper” ile kanama kontrolünün sağlandığı bir olgu

Serkan TORUN, Nuretdin SUNA, Ufuk Barış KUZU, Mahmut YÜKSEL, Zülfikar BİLGE, Onur AYDINLI, Ertuğrul KAYAÇETİN