title: Hemobilia from ruptured hepatic artery aneurysm in polyarteritis nodosa.
abstract: Hemobilia, in patients with the diagnosis of polyarteritis nodosa, is rare at clinical presentation and has a grave prognosis. We describe a case of massive hemobilia, due to aneurysmal rupture, in a patient with polyarteritis nodosa. A 39-year-old man was admitted to the hospital with upper abdominal pain. The patient had a history of partial small bowel resection, for intestinal infarction, about 5 years prior to this presentation. Abdominal computed tomography demonstrated multiple high attenuation areas in the bile duct and gallbladder. Hemobilia with blood seepage was visualized on endoscopic retrograde cholangiopancreatography; this bleeding stopped spontaneously. The following day, the patient developed a massive gastrointestinal bleed with resultant hypovolemic shock. Emergent hepatic angiogram revealed multiple microaneurysms; a communication was identified between a branch of the left hepatic artery and the bile duct. Hepatic arterial embolization was successfully performed. The underlying disease, polyarteritis nodosa, was managed with prednisolone and cyclophosphamide.
authors.affiliation: Department of Internal Medicine, Chungbuk National University College of Medicine and Medical Research Institute, Chungbuk, Korea.
authors.forename: Sung Soon
authors.initials: SS
authors.lastname: Park
authors.forename: Byeong Uk
authors.initials: BU
authors.lastname: Kim
authors.forename: Hye Suk
authors.initials: HS
authors.lastname: Han
authors.forename: Ja Chung
authors.initials: JC
authors.lastname: Goo
authors.forename: Joung Ho
authors.initials: JH
authors.lastname: Han
authors.forename: Il Hun
authors.initials: IH
authors.lastname: Bae
authors.forename: Seon Mee
authors.initials: SM
authors.lastname: Park
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000628:therapy; D004621:Embolization, Therapeutic; D006431:Hemobilia / Q000175:diagnosis / Q000209:etiology*; D006499:Hepatic Artery / Q000473:pathology*; D006801:Humans; D008297:Male; D010488:Polyarteritis Nodosa / Q000503:physiopathology*; D012421:Rupture / Q000150:complications*