Prediction of Free Bowel Perforation in Patients with Intestinal Behçet's Disease Using Clinical and Colonoscopic Findings

• Published in: Digestive diseases and sciences 2010-10, Vol.55 (10), p.2904-2911
• Main Authors: Moon, Chang Mo, Cheon, Jae Hee, Shin, Jae Kook, Jeon, Soung Min, Bok, Hyun Jung, Lee, Jin Ha, Park, Jae Jun, Hong, Sung Pil, Kim, Tae Il, Kim, Nam Kyu, Kim, Won Ho
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Distribution; Aged; Asian Continental Ancestry Group - statistics & numerical data; Behcet Syndrome - ethnology; Behcet Syndrome - pathology; Behcet Syndrome - surgery; Biochemistry; Biological and medical sciences; Child; Colonoscopy; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Hepatology; Humans; Injuries; Intestinal Perforation - ethnology; Intestinal Perforation - pathology; Intestinal Perforation - surgery; Intestines; Kaplan-Meier Estimate; Laparotomy - statistics & numerical data; Male; Medical research; Medical sciences; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Multivariate Analysis; Oncology; Original Article; Other diseases. Semiology; Predictive Value of Tests; Proportional Hazards Models; Republic of Korea - epidemiology; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Transplant Surgery; Ulcer - epidemiology; Ulcer - pathology; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Young Adult
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-009-1095-7

Background Gastrointestinal tract involvement in Behçet's disease (BD) often requires surgical intervention due to serious complications such as intestinal perforation, fistula formation, or massive bleeding. Aim The aims of this study were to investigate the clinical and surgical features of free bowel perforation and to determine the risk factors associated with this complication in intestinal BD patients. Methods We reviewed the medical records of 129 patients with intestinal BD treated from September 1988 to September 2008. Among them, 33 patients had intestinal perforations and all underwent emergent or elective laparotomy. Results The mean age of the patients with bowel perforation was 34.8 ± 15.6 years (range 12-70 years) with a sex ratio of 2.3:1 (male:female). Twenty-seven (81.8%) patients were diagnosed with intestinal BD preoperatively, whereas six (18.2%) patients were diagnosed by pathological examination after operation. Fourteen (42.4%) patients experienced postoperative recurrence of intestinal BD and 11 (33.3%) underwent reoperation. Multivariate Cox hazard regression analysis identified younger age (≤25 years) at diagnosis (HR = 3.25; 95% CI, 1.41-7.48, p = 0.006), history of prior laparotomy (HR = 5.53; 95% CI, 2.25-13.56, p = 0.0001), and volcano-shaped intestinal ulcers (HR = 2.84; 95% CI, 1.14-7.08, p = 0.025) as independent risk factors for free bowel perforation in intestinal BD. Conclusions According to the results of our study, patients diagnosed with intestinal BD younger than 25 years, who had a history of prior laparotomy or volcano-shaped intestinal ulcers have an increased risk of free bowel perforation.