Venobiliary fistula with haemobilia: a rare complication of percutaneous liver biopsy

BMJ Case Rep. 2017 Jul 14:2017:bcr2016218930. doi: 10.1136/bcr-2016-218930.

Abstract

We describe a case of a 36-year-old man with a history of chronic hepatitis C who presented with abdominal pain 3 days after undergoing a percutaneous ultrasound-guided liver biopsy. Initial investigations revealed a venobiliary fistula with haemobilia and obstructive jaundice with direct bilirubin peaking at 9.2 mg/dL. He underwent an endoscopic retrograde cholangiopancreatography with sphincterotomy and stent placement, bilirubin decreased to 3.7 mg/dL, and the patient was discharged. The patient returned with recurrent abdominal pain and upper gastrointestinal bleeding with haemoglobin of 8.6 g/dL, requiring multiple transfusions. He underwent transcatheter arterial embolisation but continued bleeding. Radiofrequency ablation was pursued and was able to achieve haemostasis. The patient was discharged. The patient returned again with a fever of 39.2 °C and was found to have a large right hepatic lobe abscess. The patient underwent abscess drainage with drain placement and was treated with antibiotics for 6 weeks. He followed up in the clinic with resolution of symptoms and infection.

Keywords: endoscopy; gastroenterology; gi bleeding; gi-stents; pancreas And biliary tract.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Biliary Fistula / diagnosis*
  • Biliary Fistula / diagnostic imaging
  • Biliary Fistula / etiology
  • Biliary Fistula / therapy
  • Biopsy, Needle / adverse effects*
  • Cholangiopancreatography, Endoscopic Retrograde
  • Diagnosis, Differential
  • Drainage
  • Hemobilia / diagnosis*
  • Hemobilia / diagnostic imaging
  • Hemobilia / etiology
  • Hemobilia / therapy
  • Hepatitis C, Chronic / pathology*
  • Humans
  • Male
  • Tomography, X-Ray Computed

Substances

  • Anti-Bacterial Agents