In Reply to: Case 0498_01 -- Unexplained lethal vasculitis posted by Editor on March 31, 1998 at 14:47:30:
I gather that this patient had an episode of hepatic artery hemorrhage of unknown ethiology requiring surgery. Although it is not stated in the history but it is possible that the surgeons knowingly or unknowingly tied the hepatic artery to control the hemorrhage. This could be verified with authopsy report and it is important because it confirms our surgical colleagues thinking that occluding hepatic artery in the presence of a patent portal vein may still result in hepatic infarct. The left lobe here escaped infarct because the left hepatic artery had a separate origin.
As for the beaded appearance of mesenteric artery with normal post mortem, I have seen this appearance when the whole length of mesenteric artery is surrounded by blood or pancreatic juice following hemorrhagic pancreatitis and because the appearance improved on follow up angiogram I believe it represented spasm, similar to what occurs in the intracranial circulation.
I assume that the pancreas was normal in this patient. The bleeding from the extrahepatic portion of the hepatic artery may heve caused the spasm and beaded appearance in the mesenteric artery branches.