Prediction of free bowel perforation in patients with intestinal Behçet's disease using clinical and colonoscopic findings.
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.


OBJECTIVE
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.
Moon
Chang Mo
CM
Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
Cheon
Jae Hee
JH
Shin
Jae Kook
JK
Jeon
Soung Min
SM
Bok
Hyun Jung
HJ
Lee
Jin Ha
JH
Park
Jae Jun
JJ
Hong
Sung Pil
SP
Kim
Tae Il
TI
Kim
Nam Kyu
NK
Kim
Won Ho
WH
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D001528:Behcet Syndrome / Q000208:ethnology* / Q000473:pathology* / Q000601:surgery; D002648:Child; D003113:Colonoscopy; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000208:ethnology* / Q000473:pathology* / Q000601:surgery; D053208:Kaplan-Meier Estimate; D007813:Laparotomy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D014456:Ulcer / Q000453:epidemiology / Q000473:pathology; D055815:Young Adult