A case of polyarteritis nodosa with intra-abdominal bleeding due to rupture of the hepatic aneurysm]

A 39-year-old woman was admitted to our hospital because of abdominal pain. She was diagnosed as intra-abdominal bleeding and an emergency laparotomy was performed. On laparotomy, massive bleeding in the abdominal cavity due to a ruptured aneurysm of the intrahepatic artery was found. We also verified small aneurysm of the common hepatic artery, tinged with red, and was suspected systemic vasculitis. The post-operative course was uneventful, but the subsequent angiography revealed many other small aneurysm of hepatic, renal and lumbar aytery. Then it was diagnosed as polyarteritis nodosa. A case of polyarteritis nodosa presenting with intra-abdominal homorrhage like this case is rare, so we presented here together with a review of the literature.     

Rapid diagnostic approach to amebic liver abscess

Summary A Viet Nam veteran was found to have a large liver abscess, almost certainly due toE. histolytica, although the organism was not recovered. A prompt diagnosis was made within 5 days of admission to the hospital, and thus proper chemotherapy and needle aspiration of the abscess were accomplished without undue delay. Confirmation of the clinical suspicion of amebiasis of the liver was achieved by a positive serologic test for amebiasis, and a large defect in the right lobe of the liver shown on radioisotope liver scan.     

Spontaneous rupture of a congenital hepatic artery aneurysm

A 74-year-old woman with new, but vague abdominal pain developed an intra-abdominal hemorrhage. Ultrasound and CT scans before and after this event demonstrated an acute hepatic lesion with hemorrhage into the peritoneal cavity. The patient died, and a ruptured hepatic artery aneurysm was revealed at autopsy. Hepatic artery aneurysm is uncommon, usually extra-hepatic, and, in most cases, is caused by atherosclerosis, medial degeneration, trauma, or infection. In this case, the aneurysm was intrahepatic and no underlying abnormalities of the hepatic vessels were found. We discuss the clinical scenario of patients with hepatic artery aneurysm and stress the importance of considering the diagnosis in the setting of a catastrophic abdominal event. In addition, the various diagnostic and therapeutic options are explored.     

Cardiac tamponade due to spontaneous rupture of large coronary artery aneurysm

A 70-year-old woman admitted with chest pain went into shock due to cardiac tamponade; 1000 mL of blood was drained from her pericardium. Enhanced computed tomography showed massive pericardial effusion and a coronary artery aneurysm in front of the main pulmonary artery. Coronary angiography revealed a coronary artery-pulmonary artery fistula and 3 giant saccular coronary artery aneurysms. Emergency surgical repair was successful.     

A recurrent case of amebic liver abscess seventeen years after the first occurrence

A 49-year-old male who had been diagnosed as having amebic liver abscess when he was 32-year-old was admitted to our hospital with fever and watery diarrhea. Ultrasonography and CT examination demonstrated a solitary abscess in the right lobe of the liver. Cysts of Entamoeba histolytica were detected in the stool and an aspiration of the liver abscess looked like anchovy paste. Serum amebic antibody by the IFA method was positive and the case was diagnosed as amebic liver abscess. The patient was treated with metronidazole, and percutaneous transhepatic abscess drainage was performed. The liver abscess decreased remarkably in size and serum amebic antibody was negative after the treatment. Recurrence of amebic liver abscess is rare and we report this case with some literature.     

尸检发现溶组织内阿米巴脑脓肿1例

<正>阿米巴脑脓肿是一种较罕见的、严重危及生命的肠外阿米巴病,多继发于肝或肺阿米巴病。本文报道1例尸检发现的阿米巴脑脓肿病例。     

Hemosuccus pancreaticus following rupture of a hepatic artery aneurysm

We describe the rare case of a hemosuccus pancreaticus as the cause of an upper gastrointestinal bleeding. A perforated common hepatic artery aneurysm caused a bleeding into the pancreas and the pancreatic duct. Besides the hepatic artery-aneurysm aneurysms of the coeliac trunc and the splenic artery were found. After the bleeding had been localised by pancreoscopy and angiography, the coeliac trunc, the tail of the pancreas and the spleen were resected without any complication.