Polyarteritis nodosa complicated by a ruptured intrahepatic aneurysm

✍ Scribed by A. A. M. Bookman; E. Goode; M. J. Mcloughlin; Zane Cohen

• Publisher: John Wiley and Sons
• Year: 1983
• Tongue: English
• Weight: 282 KB
• Volume: 26
• Category: Article
• ISSN: 0004-3591
• DOI: 10.1002/art.1780260119

✦ Synopsis

Ruptured aneurysms complicate the course of polyarteritis nodosa only infrequently. Most often they occur in renal or mesenteric vessels (1-3). One case of hepatic aneurysm rupture has been described previously (4). This report describes the clinical features of a ruptured intrahepatic aneurysm, and the lifesaving role played by angiography.

Case Report. The patient, a 42-year-old, Guyana-born actuarial clerk of East Indian heritage, was first seen at our clinic in 1978. He had a history of childhood asthma until age 13 with a transient recurrence at age 28. At age 34 an asymptomatic enlarged liver was noted. In May 1978 he developed dull aching epigastric pain that lasted 1 month. He had two more short episodes with elevated amylase. Pancreatitis was diagnosed and managed on an outpatient basis with cimetidine. Oral cholecystogram results were normal. During August 1978 he lost 12 kg and had frequent bulky greasy stools. Endoscopic retrograde cholangiopancreatography showed results characteristic of chronic pancreatitis. Treatment with dessicated pancreatic supplement normalized his stools, and his weight increased.

In October 1978 he developed severe myalgia and in November was admitted to Toronto General