Massive lower gastrointestinal bleeding due to rupture of the superior mesenteric artery branch in Behçet's disease: case report.

Background: Behçet's disease (BD) is an enigmatic autoimmune vasculitis that affects vessels of all sizes, causing corresponding symptoms in multiple organ systems. Arterial lesions in patients with BD are rare and generally involve large arteries, such as the aorta, the pulmonary artery, and the femoral arteries. Arteriorrhagia due to the mesenteric artery is a potentially life-threatening condition. To date, there are very few reports of this condition. Case presentation: We report on a 41-year-old male patient with a 4-year history of intestinal BD. He presented with atypical abdominal pain followed by massive lower gastrointestinal bleeding. The initial suspicion was a recurrence of intestinal BD. Endoscopy revealed esophageal and anastomotic ulcers. After conservative medical treatment, the disease progressed to persistent bleeding after 8 days of hospitalization. Computed tomography angiography revealed extravasation around a branch artery of the superior mesenteric artery. Following selective embolization of the superior mesenteric artery, the gastrointestinal bleeding stopped completely within a few days. After this procedure, the patient was treated with immunosuppressive therapy without any bleeding to date. Conclusion: This is a rare case in which recurrent abdominal pain and aggressive gastrointestinal bleeding were due to a rupture of the superior mesenteric artery branch, requiring a differential diagnosis from intestinal BD. A prompt endovascular intervention therapy may be lifesaving. Early initiation of immunosuppressive therapy is indicated after surgical treatment, given the inflammatory nature of vascular BD.