Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Mar 21, 2008; 14(11): 1797-1799
Published online Mar 21, 2008. doi: 10.3748/wjg.14.1797
Hemobilia due to hepatic artery aneurysm as the presenting sign of fibro-muscular dysplasia
Noam Shussman, Yair Edden, Yoav Mintz, Anthony Verstandig, Avraham I Rivkind
Noam Shussman, Yair Edden, Yoav Mintz, Avraham I Rivkind, Department of General Surgery, Hadassah Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel
Anthony Verstandig, Department of Radiology Hadassah Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel
Correspondence to: Noam Shussman MD, Department of General Surgery, Hadassah Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel. noams@hadassah.org.il
Telephone: +972-2-6778800
Fax: +972-2-6778637
Received: August 9, 2007
Revised: December 7, 2007
Published online: March 21, 2008
Abstract

Fibro-muscular dysplasia (FMD) is a rare but well documented disease with multiple arterial aneurysms. The patients, usually women, present with various clinical manifestations according to the specific arteries that are affected. Typical findings are aneurysmatic dilatations of medium-sized arteries. The renal and the internal carotid arteries are most frequently affected, but other anatomical sites might be affected too. The typical angiographic picture is that of a "string of beads". Common histological features are additionally described. Here we present a case of a 47-year-old woman, who was hospitalized due to intractable abdominal pain. A routine work-up revealed a liver mass near the portal vein. Before a definite diagnosis was reached, the patient developed massive upper gastrointestinal bleeding. In order to control the hemorrhage, celiac angiography was performed revealing features of FMD in several arteries, including large aneurysms of the hepatic artery. Active bleeding from one of these aneurysms into the biliary tree indicated selective embolization of the hepatic artery. The immediate results were satisfactory, and the 5 years follow-up revealed absence of any clinical symptoms.

Keywords: Fibro-muscular dysplasia; Hemobilia; Endovascular approach