Acute intermittent porphyria (AIP) is an autosomal dominant metabolic disorder characterized by a deficiency in heme biosynthesis. Heme biosynthesis occurs throughout the body, but it is most prominent in the erythroblastic system and liver. AIP is a hepatic porphyria whereby the liver is the source of toxic heme metabolites. Clinical manifestations of AIP result from a genetic mutation that leads to partial function of porphobiliogen deaminase (PBGD). This causes an accumulation of upstream, neurotoxic metabolites. Symptoms include but are not limited to peripheral neuropathies, autonomic neuropathies and psychiatric manifestations. AIP can be life threatening and clinical signs and symptoms are often heterogeneous and non-specific. Therefore, it is important to be able to recognize these patients to make a prudent diagnosis and offer appropriate therapy. Here, we review the epidemiology, pathophysiology, clinical presentation, diagnosis, and management of AIP including the role of liver transplantation.
Hepatic artery aneurysms are a rare phenomenon, representing 20% of visceral aneurysms. Hepatic artery aneurysm can rarely cause fistulization with the bile duct, also known as common hepatic artery-bile duct fistula. In acute settings, patients present with abdominal pain, jaundice, and gastrointestinal bleeding. Radiographic findings confirm the diagnosis. Given the rarity of this condition, there are no optimal treatment guidelines; therefore, treatment is multidisciplinary and involves definitive surgical and endoscopic management. We present a case of a common hepatic artery-bile duct fistula presenting as gastrointestinal hemorrhage.
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