Escolar Documentos
Profissional Documentos
Cultura Documentos
Ile o c e c a l U lc e r w it h a C e c o c e c a l Fis t u la in
Be h c e t ' s D is e a s e
* +
Hy u n Ky u Ch a n g , M .D. , J e e S o o Kim , M . D. , Ha in g s u b R. Ch u n g , M .D.
De p a rt m e nt o f Int e rn a l M e d ic in e , De p a rt m e nt o f Ge n e ra l S u rg e ry *,
De p a rt m e nt o f Diag n o s t ic Pat h o lo g y + ,
A s a n -Fo u n d a t io n Ka ng n u n g Ho s p it a l, Ka n g n u ng , Ko re a
Ke y W o rd s : Be h c e t 's d is e a s e , Ce c o c e c a l f is t u la , Ile o c e c a l u lc e r, A p p e n d e ct o m y
DIS C US S IO N
Fig ure 4 . Photomicrograph showing fistulous track pa rtly
BD is a multisystemic disorder characterized by oral lined by the colonic epithe lia l tissue (H&E sta in, origina l
ulcer, genital ulcer, uveitis and s kin lesions , most likely magnification40).
occurring with the underlying vasculitis. There is other
organ involvement of joints, heart and lungs , as well as the Intestinal Study Group for Behcet's disease 6 ) .
neurologic and gastrointestinal involvement. The etiology Many patients complained of gastrointestinal symptoms
remains unclear. Genetic and environmental factors s uch as nausea, vomiting and abdominal pain, but the
probably have a role in the pathogenesis. There are no ulcerative changes in the intestine were found in 1% or
specific diagnostic or laboratory tests for BD. Diagnos is less of all patients with BD7 ) . The commonest sites for the
depends upon the proper history and clinical ulcerative changes of intestinal BD were terminal ileum in
manifestations. Our case fulfilled the diagnostic criteria of 44%, followed by the ileocecal region in 34% and the
The Korea n J ourna l of Inte rnal Me dic ine
Vol. 15, No. 1, J anua ry, 2000
cecum in 12%5 ) . The clinical manifestations of intestinal 2. Monte iro H, Nogue ira R, de Ca rva lho H. Behcet's
BD are s imilar to inflammatory bowel disease, especially syndrom e and vesicovaginal fistula: an unusual
Crohn's disease. But lymphoid aggregates, submucosal complication. J Urol 1995; 153:407-408.
3. Me lua A, Ca mpbe ll N, McCluskey D, MacGowa n SW.
fibros is, no granuloma 8 ) , and deep penetrating, easily
Aorto-atrial fistula without aneury sm formation in Behcet's
perforating ulcer9 ) in Behcet's colitis help to distinguish it disease. Heart 1998; 80:200-20 1.
from Crohn's disease. Histology in our case revealed 4. Koike S, Matsumoto K, Kokubo M, Mori Y, Mura kawa S,
lymphoid aggregates, no granuloma and deep penetrating Hirose M. A case of aorto- enteric fistula after
ulcers in the ileocecal region. About 22% of the patients reconstruction of an abdominal aortic aneurysm
with intestinal BD developed symptoms mimicking associated with Behcet's disease and sp ecial references
appendicitis during the clinical course 1 0 ) . Because the to 95 rep orted cases in Japan. Nipp on Geka Gakkai
Zasshi 1988; 89:945- 95 1.
most common sites of intestinal BD are the terminal
5. Lee KS, Kim SJ , Lee BC, Yoon DS , Lee WJ , Chi HS.
ileum and the ileocecal region, some cases can be S urgical treatment of intestinal Behcet's disease. Yonsei
diagnosed as an appendicitis. Our case had a past Med J 1997; 38:455-460.
history of erroneous diagnosis with an appendectomy. 6. Inte rnationa l Study Group for Behcet's Disease (ISGBD).
The opening of the cecocecal fistula was around the s ite Criteria for diagnosis of Behcet's disease. Lancet 1990;
of the appendectomy. The exact mechanism of fistula 335:1078- 1080.
formation in BD is unclear. We could s peculate that 7. Baba S, Murata M, Ando K, Tatsu T, Endo I. Intestinal
Behcet's disease : rep ort of five cases. Dis Colon Rectum
vasculitis and ulcer necros is, along with pathergy reaction
1976; 19:428-440.
by surgical trauma in our case, might have contributed to 8. Ra nda ll GL. The colitis of Be hcet's syndrome. Am J Surg
the fistula formation. Pathol 1986; 10:888- 893.
9. Kasa ha ra Y, Ta na ka S , Nishino M, Uremura H, Shira ha
REF ERENC ES S, Kuya ma T. Intestinal involvement in Behcet's disease:
re vie w of 136 surgical cases in the Japanese literature.
1. The LS , Gree n KA, O'Sulliva n MM, Morris JS , Willia ms Dis Colon Rectum 198 1; 24:103- 106.
BD. Behcet's sy ndrome : severe proctitis with rectovaginal 10. Koda ma H. Intestinal Behcet's (Jap). S urg Ther 1977;
fistula formation. Ann Rheum Dis 1989; 48:779- 780. 37:5 1- 58.