Fifty-five-year-old male develops hemobilia ten minutes after liver biopsy
A 55-year-old man developed acute symptomatic hemobilia roughly ten minutes after finishing an ultrasound-guided percutaneous liver biopsy, Cureus reported. Medical teams expected a routine diagnostic procedure for a liver lesion on a patient with chronic hepatitis B. Instead, the patient suffered sudden right upper quadrant pain and hematemesis while still in the procedure room.
The patient presented with mild anemia, showing a hemoglobin level of 12.5 grams per deciliter, though his platelet count and prothrombin activity remained normal. Doctors targeted a 40-by-39-millimeter hepatic lesion categorized as a Liver Imaging Reporting and Data System category four at the junction of hepatic segments IVa, IVb, and VIII. Clinicians retrieved three core biopsy specimens using a semi-automatic 16G by 15 cm Tru-Cut core biopsy needle with a 15G by 10 cm coaxial introducer under real-time ultrasound guidance.
Bedside ultrasound captures acute gallbladder changes
Bedside ultrasound revealed newly developed echogenic material filling about half of the gallbladder lumen just ten minutes post-procedure. A pre-procedural scan had confirmed an anechoic gallbladder with a thin wall and no intraluminal sludge.
Post-biopsy hemobilia typically presents hours to days following the procedure, with a mean interval of roughly five days. Immediate symptomatic presentations remain rare in medical literature. While previous cases documented asymptomatic findings detected by ultrasound immediately after intervention, this patient experienced severe abdominal pain and vomiting blood almost instantly.
Conservative management leads to an uneventful three-day discharge
Doctors elected conservative management because the patient remained hemodynamically stable without imaging proof of ongoing hemorrhage. A hemoglobin test administered six hours after the biopsy registered 12.3 grams per deciliter, holding steady at that level the following day. The patient required no blood transfusions, endoscopic interventions, angiography, or embolization as his abdominal pain resolved completely.
Hospital staff discharged the patient after three days of clinical observation. An outpatient follow-up appointment five weeks later confirmed he remained completely asymptomatic, rendering further imaging unnecessary.
Frequently asked questions about post-biopsy hemobilia
Why did hemobilia develop so quickly in this patient?
While the exact vascular mechanism remains unconfirmed on computed tomography, clinicians suspect a transient vascular injury that communicated with the biliary tract before sealing off spontaneously. The close temporal relationship between needle insertion and symptom onset points directly to the intervention.
What were the exact lab values before the liver biopsy?
The patient’s pre-procedural hemoglobin measured 12.5 grams per deciliter, his platelet count stood at 280,000 per microliter, and his prothrombin activity was 75 percent.
Related reading