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• W2978875576 abstract "Liver biopsy is usually a safe procedure, with the rate of serious complications being around 1 percent. While pain and transient hypotension are the minor complications, patients can develop serious hemorrhagic complications. We describe a case of life-threatening GI bleeding secondary to pseudo aneurysm and presentation suggestive of hemobilia after liver biopsy, in a female with no risk factors for bleeding. 47-year-old female with hypertension, diabetes mellitus and hyperlipidemia who presented with severe, intermittent, colicky upper abdominal pain and one episode of blood in stools 10 days after an ultrasound guided liver biopsy done for hepatic lesions seen on MRI. Physical exam revealed scleral icterus and severe tenderness in epigastrium with no rebound. Labs showed a hemoglobin of 12.2 g/dL, platelets of 164x103/uL, total bilirubin of 2.7 mg/dL with direct bilirubin of 2.3 mg/dL, ALT of 509 U/L, AST of 521 U/L, ALP of 205 U/L and normal lipase. Soon after admission, she developed hemodynamically significant GI bleeding and was transferred to the ICU and given blood transfusions. CT abdomen showed amorphous material in the stomach, duodenum and small bowel, compatible with hemorrhage. MRCP showed the previously visualized hepatic lesions. ERCP showed benign biliary papillary stenosis with no filling defect or blood in the biliary duct and colonoscopy did not reveal a source of bleeding. Tagged RBC scan also failed to reveal any site of bleeding. She had an arteriogram under interventional radiology, which revealed focal pseudoaneurysm, with hepatic artery to portal vein fistula at the low branch of the left hepatic artery and was embolized with gel foam particles and coil. She improved symptomatically over the next few days and was discharged. We believe that the patient developed traumatic pseudoaneurysm that eroded into the biliary system causing delayed intermittent hemobilia after liver biopsy. This would explain the presentation of pain, bilirubinemia along with significant upper GI bleeding. Bleeding after liver biopsy can be intraperitoneal bleed, intrahepatic or subcapsular hematomas and rarely, hemobilia. A study found the incidence of hemobilia to be 0.006 percent. Hemobilia because of pseudo aneurysm may present in a delayed fashion when the pseudo aneurysm erodes into the biliary system. It may resolve with conservative management, but ongoing bleeding will require angiographic embolization or surgery.Table 1: Laboratory Values of the PatientFigure 1" @default.
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• W2978875576 date "2016-10-01" @default.
• W2978875576 modified "2023-09-27" @default.
• W2978875576 title "Life Threatening Upper GI Bleeding as a Complication of Liver Biopsy" @default.
• W2978875576 doi "https://doi.org/10.14309/00000434-201610001-02004" @default.
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