Hemobilia from ruptured hepatic artery aneurysm in polyarteritis nodosa

Korean J Intern Med. 2006 Mar;21(1):79-82. doi: 10.3904/kjim.2006.21.1.79.

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.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aneurysm, Ruptured / complications*
  • Aneurysm, Ruptured / therapy
  • Embolization, Therapeutic*
  • Hemobilia / diagnosis
  • Hemobilia / etiology*
  • Hepatic Artery / pathology*
  • Humans
  • Male
  • Polyarteritis Nodosa / physiopathology*
  • Rupture / complications*