Aortic aneurysm: a rare complication of ulcerative colitis / Aortik anevrizma: Ulseratif kolitin nadir gorulen bir komplikasyonu.

Ulcerative colitis is an idiopathic chronic inflammatory disorder localized in the colon and rectum. Systemic and extraintestinal complications of ulcerative colitis are arthritis, delayed growth and sexual maturation, nutritional deficiency secondary to malabsorbtion, mucocutaneous lesions, renal disease, hepatobiliar disease and ocular complications (1). Cardiac complications including myocarditis, pericarditis and increased risk of infective endocarditis may be rarely seen during the clinical course but aortic aneurysm is an extremely rare complication of ulcerative colitis (2-4).

A 16-year-old boy was admitted to our hospital because of delayed growth, pruritic mucocutaneous lesions, bloody diarrhea and seizures.

Medical history revealed that he had apparently been well until one year old. It was learned that pruritic mucocutaneous lesions first began on face and trunk and aggravated with sun exposure. Bloody diarrhea, abdominal pain, tenesmus, and tonic-clonic convulsions were also noted by his parents after age of one year old. There was no history of exposure to tuberculosis, sick persons, or animals, and there was no family history of allergy. Parents were first-degree relatives.

His axillary temperature, pulse, respiratory rate, and blood pressure were 36.8 [degrees]C, 123/min, 28/min, and 106/56 mmHg, respectively. His height was 124 cm (below the 3rd percentile), and his weight was 21.8 kg (below the 3rd percentile).

Physical examination revealed chronic dermatitis on trunk and face and a perianal fistula.

Hemoglobin, hematocrit, mean corpuscular volume, white cell count, erythrocyte sedimentation rate, and serum C-reactive protein levels were 7.4 g/dl, 25.9%, 53.4 [micro][m.sup.3], 15.200/ml, 36 mm/hr, and 22.3 mg/dl, respectively. He had thrombocytosis. Hypochromic and microcytic erythrocytes were observed on stained blood smear. Stool examination revealed occult blood. Urinalysis was normal.

Serum aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase levels were 12 U/L, 5 U/L, and 425 U/L, respectively.

Serum total protein, albumin, globulin, immunoglobulin G and E levels were 7.3 g/dl, 3.1 g/dl, 4.2 g/dl, 14.2 g/l, and 907.3 IU/ml, respectively. Pathergy test and VDRL were negative. Test for perinuclear antineutrophil cytoplasmic antibodies (pANCA) was positive.

Cardiac examination was normal but telecardiography showed a prominent aorta. Echocardiography revealed aneurysm of both ascending and descending aorta.

Rectosigmoidoscopy revealed a pale, edematous and fragile mucosa and loss of vascular pattern. Rectal biopsy showed crypt distortion and cryptitis, with heavy mixed inflammatory cell infiltration (mostly plasma cells and eosinophils) within lamina propria.

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Barium enema revealed pseudodiverticula and lead pipe sign in the transverse colon (Fig. 1). Cranial magnetic resonance imaging was normal. Electroencephalography revealed epileptic activity in temporal, parietal and occipital regions.

Cardiac catheterization showed aortic aneurysm of ascending and descending aorta (Fig. 2, Video 1. See corresponding video/movie images at www.anakarder.com). There was no pressure gradient between the ascending and descending aorta.

Oral prednisolone and sulfasalazine treatments were given for ulcerative colitis, metronidazole for perianal fissure, and sodium valproate therapy for epilepsia. Aortic graft surgery for aneurysm was planned after the inflammation control with prednisolone and sulfasalazine (5).

In conclusion we described patient who had aortic aneurysm as a rare complication of ulcerative colitis. If treatment is initiated earlier, this complication may be prevented.

References

(1.) Hanaver SB. Inflammatory bowel disease. N Engl J Med 1996; 334: 841-8.

(2.) Kreuzpaintner G, Horstkotte D, Heyll A, Losse B, Strohmeyer G. Increased risk of bacterial endocarditis in inflammatory bowel disease. Am J Med 1992; 92: 391-5.

(3.) Granot E, Rottem M, Rein AJ. Carditis complicating inflammatory bowel disease in children. Case report and review of the literature. Eur J Pediatr 1988; 148:203-5.

(4.) Farley JD, Thomson AB, Dasgupta MK. Pericarditis and ulcerative colitis. J Clin Gastroenterol 1986; 8: 567-8.

(5.) Shiono M, Hata M, Sezai A, lida M, Negishi N, Sezai Y. Reoperation for ascending aortic aneurysm, coronary ostial aneurysm and patent Cabrol trick after Bentall operation for aortitis syndrome. Circ J 2005; 69: 861-4.

Address for Correspondence/Yazisma Adresi: Cemsit Karakurt, Inonu University Faculty of Medicine, Unit of Pediatric Cardiology, Malatya, Turkey Phone: [phone]/5302 Fax: [phone] E-mail: [e-mail]

Cemsit Karakurt, Gulendam Kocak, Ayse Selimoglug *, Metehan Ozen **

From Units of Pediatric Cardiology, * Pediatric Gastroenterology and ** Pediatric Infectious Disease, Faculty of Medicine, University of Inonu, Malatya, Turkey