Park Sung Soon, Kim Byeong Uk, Han Hye Suk, Goo Ja Chung, Han Joung Ho, Bae Il Hun, Park Seon Mee
Department of Internal Medicine, Chungbuk National University College of Medicine and Medical Research Institute, Chungbuk, Korea.
Korean J Intern Med. 2006 Mar;21(1):79-82. doi: 10.3904/kjim.2006.21.1.79.
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.
在结节性多动脉炎患者中，血胆症在临床表现上较为罕见，且预后严重。我们描述一例结节性多动脉炎患者因动脉瘤破裂导致大量血胆症的病例。一名39岁男性因上腹部疼痛入院。该患者在此次发病前约5年有因肠梗死行部分小肠切除术史。腹部计算机断层扫描显示胆管和胆囊内有多个高密度区。在内镜逆行胰胆管造影术中可见血胆症伴血液渗漏；此次出血自行停止。次日，患者发生大量胃肠道出血，继而出现低血容量性休克。急诊肝血管造影显示多个微动脉瘤；发现左肝动脉一分支与胆管之间存在交通。成功进行了肝动脉栓塞术。潜在疾病结节性多动脉炎采用泼尼松龙和环磷酰胺治疗。
