Hemobilia causing acute pancreatitis after percutaneous liver biopsy

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

We report a case of a 75-year-old woman who developed acute cholecystitis and acute pancreatitis due to hemobilia after a percutaneous liver biopsy. She was admitted to our hospital 13 days after the procedure. The patient presented with cholangitis and acute biliary pancreatitis and underwent endoscopic retrograde cholangiopancreatography (ERCP). Active hemobilia was observed during the ERCP, and sphincterotomy and stent placement were carried out. Angiography was performed because of ongoing bleeding and demonstrated multiple arterioportal fistulas. The bleeding vessel was successfully embolized through an angiographic catheter with microcoils and Histoacryl glue.

Acute Pancreatitis Secondary to Hemobilia after Percutaneous Liver Biopsy: A Rare Complication of a Common Procedure, Presenting in an Atypical Fashion

Percutaneous Liver Biopsy is an often-required procedure for the evaluation of multiple liver diseases. The complications are rare but well reported. Here we present a case of a 60-year-old overweight female who underwent liver biopsy for elevated alkaline phosphatase. She developed acute pancreatitis secondary to hemobilia, with atypical signs and symptoms, following the biopsy. She never had the classic triad of RUQ pain, jaundice, and upper GI hemorrhage. There were also multiple negative imaging studies, thus complicating the presentation. She was successfully treated with ERCP, sphincterotomy, balloon sweep, and stent placement. Angiography and transcatheter embolization were not required.

Unusual complications of gallstones

Extrinsic compression of the bile duct from gallstone disease is associated with bilio-biliary fistulization, requiring biliary-enteric reconstruction. Biliary-enteric fistulas are associated with intestinal obstruction at various levels. The primary goal of therapy is relief of intestinal obstruction; definitive repair is performed for selected patients. Hemobilia from gallstone-related pseudoaneurysms is preferentially controlled by selective arterial embolization. Rapidly increasing jaundice with relatively normal liver enzymes is a diagnostic hallmark of bilhemia. Acquired thoraco-biliary fistulas are primarily treated by percutaneous and endoscopic interventions.

Acute pancreatitis secondary to hemobilia after percutaneous liver biopsy

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 following liver resection: report of three fatal cases and a review of the literature

Pancreatitis is a well recognised but rare complication following liver resection. The precise aetiology is not well understood and the clinical diagnosis may frequently be obscured by the postoperative state. Postoperative pancreatitis has a high mortality rate and should always be considered in patients who unexpectantly deteriorate postoperatively. We present three fatal cases of pancreatitis following liver resection. The literature is reviewed to elucidate common factors in patients who develop postoperative pancreatitis.

Arterioportal fistula causing acute pancreatitis and hemobilia after liver biopsy

We report the case of a 49-year-old patient who developed hemobilia and acute pancreatitis from an arterioportal fistula after a percutaneous liver biopsy, and we analyze diagnostic testing and management based on a concise review of the available literature. Hemobilia can present as late as 10 days after liver biopsy. Acute pancreatitis is a rare complication of hemobilia. To our knowledge, this is the first documented case of an arterioportal fistula after percutaneous liver biopsy with the late manifestation of hemobilia and acute pancreatitis.

Haemobilia causing acute pancreatitis after percutaneous liver biopsy: diagnosis by magnetic resonance cholangiopancreatography

Magnetic resonance cholangiopancreatography (MRCP) has received much attention as a non-invasive alternative to endoscopic retrograde cholangiopancreatography, primarily for investigation of choledocholithiasis, but also for evaluation of less common biliary anomalies. We present a case of haemobilia causing acute pancreatitis after percutaneous liver biopsy in which the diagnosis could be made clearly by MRCP, thus avoiding endoscopic retrograde cholangiopancreatography and sphincterotomy.

Pancreatitis and haemobilia due to arterioportal fistula after percutaneous liver biopsy resolved by selective arterial embolization

Haemobilia and arterioportal fistula are uncommon complications secondary to percutaneous liver biopsy. We report the case of a patient who developed haemobilia and subsequently acute pancreatitis as a result of a liver biopsy. Selective hepatic angiogram showed an arterioportal fistula. Transcatheter arterial embolization successfully occluded the fistula. The patient remained asymptomatic 4 months later. We review the published literature concerning acute pancreatitis associated with haemobilia and draw conclusions for management of similar cases in the future.

Hemobilia, a rare cause of acute pancreatitis after percutaneous liver biopsy: diagnosis and treatment by endoscopic retrograde cholangiopancreatography

We here report the case history of a 75-yr-old woman who developed pancreatitis and recurrent symptomatic, cholestasis-induced hemobilia after percutaneous liver biopsy. An endoscopic sphincterotomy with clot extraction led to relief of symptoms. The risk of hemobilia after percutaneous liver biopsy is less than one per 1000 procedures, and only two cases of acute pancreatitis after percutaneous liver biopsy have previously been reported. To our knowledge, this is the first case in which endoscopic retrograde cholangiopancreatography was used to both diagnostic and therapeutic ends.