title: Gastrointestinal bleeding as the initial manifestation of a polyarteritis nodosa-associated hepatic artery aneurysm-duodenal fistula--a case report.
abstract: The authors report an unusual case of upper gastrointestinal bleeding from a hepatic artery aneurysm-duodenal fistula in a 21-year-old male. Arteriography revealed multiple visceral artery aneurysms. Biopsy of the hepatic artery aneurysm (HAA) revealed focal areas of necrosis, medial degeneration, fibrosis, and giant cells. The necrotizing vasculitis plus the multiple visceral aneurysms were highly suggestive of polyarteritis nodosa (PAN). This report reviews the pathophysiology and management of PAN and the diagnosis and management of HAA.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Missouri-Columbia, Columbia, MO 65212, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Shuster
authors.forename: Jose
authors.initials: J
authors.lastname: Almeida
authors.forename: Richard
authors.initials: R
authors.lastname: Coats
authors.forename: Ajay
authors.initials: A
authors.lastname: Kalra
authors.forename: Donald
authors.initials: D
authors.lastname: Silver
mesh_terms: D000328:Adult; D000783:Aneurysm / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D004378:Duodenal Diseases / Q000175:diagnosis / Q000209:etiology*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006499:Hepatic Artery / Q000473:pathology; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D010488:Polyarteritis Nodosa / Q000150:complications* / Q000503:physiopathology