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

Hemobilia from Ruptured Hepatic Artery Aneurysm in Polyarteritis Nodosa

• Park SS
• Kim BU
• Han HS
• Goo JC
• Han JH
• Bae IH
• Park SM

• KMID: 1782258
• DOI: http://doi.org/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.

Keyword

Hemobilia; Polyarteritis nodosa

MeSH Terms

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