Ruptured Suprarenal Abdominal Aortic Pseudoaneurysm with Superior Mesenteric and Celiac Arteries Occlusion, Revealing Behçet's Disease: A Case Report

Abstract

Behçet's disease (BD) is a multisystemic, chronic autoimmune inflammatory vasculitic disease with an unknown etiology. Although the literature reports that vascular involvement occurs in 7% to 38% of all BD cases, the arteries are rarely involved; however, arterial involvement is usually associated with significant mortality and morbidity. We report the case of a young female patient who presented to the emergency department with severe abdominal pain and a history of weight loss. The patient was evaluated using computed tomography angiography, which revealed a ruptured suprarenal aortic pseudoaneurysm with occlusion of both the superior mesenteric and celiac arteries. Urgent surgery was performed with aortic repair with an interposition graft and superior mesenteric artery embolectomy. The patient's clinical history and radiological imaging findings were strongly suggestive of the diagnosis of BD with vascular involvement.

Keywords: Behcet disease; False aneurysm; Superior mesenteric artery; Suprarenal aorta; Vasculitis.

Fig. 1

Preoperative multiplane computed tomographic angiograms, (A) sagittal, (B) axial, and (C) coronal, showing a ruptured aortic false aneurysm (yellow arrows) with hematoma tracking upward to the level of the diaphragm (red arrow).

Fig. 2

Preoperative three-dimensional reconstruction of the computed tomographic angiogram showing a false aneurysm (yellow arrow). Both the celiac artery and superior mesenteric artery are occluded (not shown), but both renal arteries are patent (red arrows).

Fig. 3

Postoperative 6 months follow-up three-dimensional reconstruction of the computed tomographic angiogram, showing patent bypass (yellow arrow), superior mesenteric artery (red arrow), and left and right renal arteries (white arrows).