[A case of ruptured aneurysm of the thoraco-abdominal aorta associated with Behçet's disease]

A 41-year-old male with incomplete type of Behçet's disease was operated on because of ruptured aneurysm of the thoraco-abdominal aorta. A saccular pseudoaneurysm developed by rupture of the aortic wall involved the left postero-lateral portion of the supra-renal abdominal aorta. The defect in the aneurysm was closed using Dacron patch. The post-operative course was uneventful. However, seven months after discharge, the patient developed severe back pain at midnight, and was referred to our institution. On physical examination, a pulsatile mass was found in the right epigastric area. CT and DSA showed saccular pseudoaneurysm at the patch anastomotic site. Extra-anatomic long bypass grafting was performed from the ascending aorta to the infra-renal abdominal aorta. The abdominal aorta was occluded just below the diaphragm and the supra-renal portion of the aorta. Reconstruction of coeliac artery and superior mesenteric artery was made using branch grafts attached to the long graft. Surgical treatment of the complicated Behçet's disease should include extra-anatomic bypass, especially in the re-operative cases of ruptured aneurysm of the aorta.