Hemobilia from ruptured hepatic artery aneurysm in polyarteritis nodosa.
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.
Park
Sung Soon
SS
Department of Internal Medicine, Chungbuk National University College of Medicine and Medical Research Institute, Chungbuk, Korea.
Kim
Byeong Uk
BU
Han
Hye Suk
HS
Goo
Ja Chung
JC
Han
Joung Ho
JH
Bae
Il Hun
IH
Park
Seon Mee
SM
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*