Hemobilia from ruptured hepatic artery aneurysm in polyarteritis nodosa.

The Korean Journal of Internal Medicine
Sung Soon ParkSeon Mee Park

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.

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Citations

Jul 28, 2013·The Surgical Clinics of North America·William Wu, Rabih A Chaer
Oct 12, 2010·La Revue de médecine interne·G GeriP Cacoub
May 1, 2012·The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi·Kook Hyun Kim, Tae Nyeun Kim
Mar 29, 2011·Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases·Charles J ChoBin Yoo
Mar 14, 2020·ANZ Journal of Surgery·Elizabeth LockieBenjamin Thomson

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Methods Mentioned

BETA
biopsy

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