Massive Hemorrhage Due to Rupture of A Right Iliac Aneurysm Revealing Behcet's Disease: A Case Report From the Festoc Center in Bamako

Abstract

Introduction: Behçet's disease is a chronic inflammatory disorder. It is clinically characterized by oral and genital aphthoses; skin lesions and systemic manifestations. Arterial aneurysms are defined as a loss of parallelism of the arterial walls, localized to an arterial segment, and corresponding to an increase of at least 50% of the normal arterial diameter. We report a case of Behcet's disease revealed by a ruptured aneurysm of the right primitive iliac artery. Observation: This was a 44-year-old patient with no known history, referred for management of a right inguinal mass that had progressively increased in volume and had been evolving for about 1 month. On admission, the physical examination revealed conjunctival pallor, a pulsatile right inguinal mass approximately 10 cm in diameter, and a suppurating sore on the scrotum. Doppler ultrasound of the lower limbs revealed an aneurysm of the right common iliac artery. The aneurysm ruptured during the short preparation period for surgery, resulting in cataclysmic hemorrhage. This prompted manual compression and the transfusion of several packed red blood cells. During transport to the OR, the patient experienced hemorrhagic shock and altered consciousness, prompting the administration of drugs (noradrenaline) and emergency orotracheal intubation. The aneurysm was controlled upstream and downstream by approaching the right primitive iliac artery, followed by dissection and clamping after general heparinization. The common femoral artery was then approached and checked. Surgical exploration revealed numerous clots which were evacuated, revealing a large neck extending over 7 cm. The procedure involved reconstruction of the common femoral artery with a patch saphenous graft and excision of the necrotic tissue. The post-operative course was marked by suppuration of the surgical wound, which progressed well with appropriate antibiotics and local care. Conclusion: Arterial involvement in Behçet's disease manifests as arterial thrombosis or, more frequently, aneurysm. This is due to inflammation of the media, intima and vasa vasorum. Their management can be envisaged in our context.