Acute pancreatitis secondary to hemobilia after percutaneous liver biopsy

Abstract

Percutaneous liver biopsy (PLB) is a valuable diagnostic tool. Complication rates vary depending on the technique used, experience of the physician, number of passes, bleeding parameters and other factors. Hemorrhage is a common complication after PLB and can present as intraperitoneal bleeding, intrahepatic or subcapsular hematoma, or rarely as hemobilia. Acute pancreatitis is a rare complication of hemobilia. We describe a single case of acute pancreatitis caused by biliary obstruction due to hemobilia following PLB. The obstruction was successfully managed with biliary stent drainage.

Acute Pancreatitis Caused by Hemobilia: An Unusual Complication of Laparoscopic Cholecystectomy

“…This can be confirmed with a side-view endoscopy, which will show a blood clot or bleeding from ampulla. Another useful investigation is MRCP, which can show biliary dilatation and irregular filling defects 9. In our case, the clot may have passed into the duodenum, which is why the MRCP did not show any filling defects.…”

“…It has been reported after liver biopsy, percutaneous transhepatic biliary drainage, and hepatocellular carcinoma 7-9. To date, there is one report of a case of AP caused by hemobilia due to hepatic artery pseudoaneurysm after LC 3.…”

Hemobilia Causing Acute Cholecystitis and Pancreatitis after Percutaneous Liver Biopsy: A Case Report and Review of the Literature

“…However, the first documented case report appeared in 1975 [12]. In the published literature, we found 37 cases of acute pancreatitis induced by hemobilia [5, 11-44]. Nineteen cases were secondary to percutaneous liver biopsy, 4 cases due to hepatic artery aneurysm, 4 cases were secondary to hepatocellular carcinoma, and 3 cases due to post-cholecystectomy.…”

“…In advanced stage of cirrhosis and chronic liver disease, a Tru-Cut needle is recommended for preserving tissue integrity. Bleeding can manifest as intraperitoneal bleeding or intrahepatic or subcapsular hematoma [5]. The emergence of bleeding as hemobilia is very rare after percutaneous liver biopsy.…”

Complications of Liver Biopsy

“…In 1991 Merrell and Schneider described the evolution of haemobilia and suggested a lag time between biopsy and presentation to be about 5 days. Interestingly, haemobilia after biopsy has been associated with acute pancreatitis (Pena, Horn and Cross 2009). It is thought that the pancreatitis is induced in the same manner as gallstones; impairment of pancreatic drainage.…”