S3523 Rare Complication of Liver Biopsy

Abstract

INTRODUCTION: Bleeding from the hepatobiliary tract is an unusual cause of the acute upper gastrointestinal bleed. Liver biopsy is deemed a safe and highly effective procedure to diagnose numerous liver conditions. Since its introduction at the end of the 19th century, modern imaging methods, special needles, and clinical experience have significantly reduced the rate of complications associated with liver biopsy. Hemoperitoneum, sub-capsular hematoma, pneumothorax, sepsis, and haemobilia are rare complications associated with liver biopsy. We are presenting a case of haemobilia, which resulted as a complication of liver biopsy and its management. CASE DESCRIPTION/METHODS: A 62-year-old male presented after an episode of hematemesis, severe right upper abdominal pain, jaundice, and melena after transjugular liver biopsy for evaluation of autoimmune hepatitis. Abdominal ultrasound showed dilated common bile duct (CBD), indicating biliary obstruction. Upper endoscopy, however, showed no signs of ongoing or old bleeding. These findings were followed by endoscopic retrograde cholangiopancreatography (ERCP) with discovery of blood clots in the CBD, revealing the diagnosis of haemobilia. The blood clots were removed and followed by placement of a plastic stent in the CBD. The patient, however, underwent a repeat ERCP with replacement of CBD stent as he continues to have melena requiring multiple blood transfusions. After the deployment of metal stent, patient's abdominal pain started to improve and his hemoglobin level stabilized. The third ERCP was performed 4 days later, which confirmed the resolution of haemobilia. The patient's symptoms continued to improve and was discharged after 29 days of hospitalization. DISCUSSION: Percutaneous or transjugular liver biopsies are performed very frequently for evaluation of causes of liver conditions in a safe and effective way. Complications associated with liver biopsy are uncommon, but severe complications do occur. Our case illustrates a distinctive way of managing such rare complication with advanced techniques like biliary stenting.