Fatal hemobilia resulting from an iatrogenic arteriobiliary fistula as a rare complication of transjugular liver biopsy

Gurakuqi, Gerald; Stadlbauer, Vanessa; Portugaller, Horst; Högenauer, Christoph; Trauner, Michael; Stauber, Rudolf

doi:10.1097/meg.0b013e3282748f32

Cited by 15 publications

(8 citation statements)

References 11 publications

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“…Therefore, aggressive treatment is usually considered for treating intrahepatic pseudoaneurysms because of the risk of rupture, even though patients are hemodynamically stable (4,6). Transarterial embolization of the bleeding or pseudoaneurysm has been shown to be a safe and effective treatment for these arterial complications (4)(5)(6)(7)(8). However, transarterial embolization may induce liver function deterioration with liver ischemia occurring during the early post-LDLT period as hepatic arterial flow is important for regeneration of the engrafted liver (9).…”

Section: Discussionmentioning

confidence: 99%

Intrahepatic Pseudoaneurysms Complicating Transjugular Liver Biopsy in Liver Transplantation Patients: Three Case Reports

Jang

Yoon

et al. 2010

J Korean Soc Radiol

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Transjugular liver biopsy (TJLB) is an accepted alternative method of obtaining hepatic tissue for pathologic diagnosis in patients with parenchymal liver disease, but in whom conventional percutaneous transhepatic liver biopsy is contraindicated due to coagulopathy, a large amount of ascites, or massive obesity (1, 2). Transjugular liver biopsy is also indicated in patients with liver function deterioration following liver transplant and in patients with congenital clotting disorders (1, 2).There are generally few complications following TJLB; the liver-puncture-related major complication rate was reported to be 0.2% in a review of 64 published reports involving 7,493 adults who had undergone TJLBs (2). We have treated 3 patients with intrahepatic pseudoaneurysms following 503 TJLBs in 320 liver transplant recipients since 2005, and report our experience for managing intrahepatic pseudoaneurysms following TJLB. Case Reports Case 1A 34-year-old man who had undergone right lobe living donor liver transplantation (LDLT) 24 days previously was referred to our department for TJLB caused by deteriorating liver function. The laboratory data were as follows: serum aspartate aminotransferase, 297 IU/L; alanine transaminase, 497 IU/L; total bilirubin, 8.7 mg/dL; hemoglobin, 10.4 g/dL; platelet count, 243 × 10 3 /mm 3 ; and international normalized ratio (INR), 1.02. Although coagulation function was normal, the clinician in charge preferred TJLB to percutaneous transhepatic biopsy in order to avoid the risk of post-biopsy bleeding. A pre-TJLB CT revealed no abnormal findings in the liver graft. A TJLB (5 passes) using an 18-gauge Quick-Core biopsy needle (Cook, Bjaeverskov, Denmark) was performed uneventfully in the right hepatic vein. A pathology examination revealed severe canalicular and ductular cholestasis without evidence of rejection. The liver function gradually improved; however, the hemoglobin level fluctuated between 7.9 and 8.9 g/dL from 4 days post- An intrahepatic pseudoaneurysm is a rare complication following transjugular liver biopsy. Transarterial embolization is considered a safe and effective treatment for treating pseudoaneurysms. Herein we report three cases of intrahepatic pseudoaneurysms following transjugular liver biopsies. The three pseudoaneurysms were managed by the following methods: transarterial embolization, percutaneous transhepatic embolization, and close observation.

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Section: Discussionmentioning

confidence: 99%

Intrahepatic Pseudoaneurysms Complicating Transjugular Liver Biopsy in Liver Transplantation Patients: Three Case Reports

Jang

Yoon

et al. 2010

J Korean Soc Radiol

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“…Diagnostic percutaneous transhepatic cholangiography (PTC), percutaneous liver biopsy and percutaneous transhepatic cholangiography and biliary drainage (PTCD) placement have all been associated with developing hemobilia . Specifically for percutaneous liver biopsy, there have been inconsistent findings in the literature.…”

Section: Causes Of Hemobiliamentioning

confidence: 99%

Hemobilia: Historical overview, clinical update, and current practices

Zhornitskiy

Berry

Han

et al. 2019

Liver International

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Hemobilia refers to macroscopic blood in the lumen of the biliary tree. It represents an uncommon, but important, cause of gastrointestinal bleeding and can have potentially lethal sequelae if not promptly recognized and treated. The earliest known reports of hemobilia date to the 17th century, but due to the relative rarity and challenges in diagnosis of hemobilia, it has historically not been well‐studied. Until recently, most cases of hemobilia were due to trauma, but the majority now occur as a sequela of invasive procedures involving the hepatopancreatobiliary system. A triad (Quincke's) of right upper quadrant pain, jaundice and overt gastrointestinal bleeding has been classically described in hemobilia, but it is present in only a minority of patients. Therefore, prompt diagnosis depends critically on a high index of suspicion based on a patient's clinical presentation and a history of recently undergoing hepatopancreatobiliary intervention or having other predisposing factors. Treatment of hemobilia depends on the suspected source and clinical severity and thus ranges from supportive medical care to urgent advanced endoscopic, interventional radiologic, or surgical intervention. In the present review, we provide a historical perspective, clinical update and overview of current trends and practices pertaining to hemobilia.

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“…Transjugular biopsy can also cause massive, even lifethreatening, hemobilia. 16 Other iatrogenic causes of hemobilia include ERCP and hepatobiliary surgery. ERCP-related injury includes bile duct perforation, as can occur during removal of stones.…”

Section: Etiologymentioning

confidence: 99%

Hemobilia

Navuluri

2016

Semin intervent Radiol

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Hemobilia is a rare source of upper gastrointestinal bleeding, though the incidence is increasing along with the rise in minimally invasive biliary interventions. Prompt diagnosis and treatment rests on having appropriate clinical suspicion which should be based on the patient's presenting signs and symptoms, as well as history including recent instrumentation. Endoscopy should be reserved for cases of upper gastrointestinal bleeding with low suspicion for hemobilia. Interventional radiology may be the first-line diagnostic and therapeutic option for patients with a high suspicion of hemobilia. While embolization is the mainstay of therapy, other options include thrombin injection, stent placement, and/or placement of a percutaneous biliary drain. Surgery should be reserved for failed treatment by interventional radiology.

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Fatal hemobilia resulting from an iatrogenic arteriobiliary fistula as a rare complication of transjugular liver biopsy

Cited by 15 publications

References 11 publications

Intrahepatic Pseudoaneurysms Complicating Transjugular Liver Biopsy in Liver Transplantation Patients: Three Case Reports

Intrahepatic Pseudoaneurysms Complicating Transjugular Liver Biopsy in Liver Transplantation Patients: Three Case Reports

Hemobilia: Historical overview, clinical update, and current practices

Hemobilia

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