58-yo Patient Experiences Severe Hemobilia Post Liver Biopsy

GI Endoscopy · 1 min read

Hemobilia, though rare, can be a severe post-procedure complication, requiring prompt diagnosis and effective treatment.

Experienced teaching points

Clinical Pearls

Hemobilia is a rare but severe complication that can follow liver biopsy, presenting with Quinke's triad: epigastric pain, jaundice, and gastrointestinal bleeding.
Diagnosis typically involves a combination of endoscopy, CT imaging, and ERCP with cholangiography to identify the source of bleeding in the biliary tree.
Endoscopic management often requires biliary sphincterotomy, extraction of blood clots, and insertion of a plastic stent to ensure biliary decompression and drainage.

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Background:
- Patient details: 58 years old, NAFLD, diabetes mellitus, hypertension
- Procedure: Underwent liver biopsy
Symptoms 24hrs post-biopsy:
- Acute abdominal pain
- Jaundice & chills
- Melenic stools
Emergency Room Findings:
- Low blood pressure & rapid heart rate
- Icteric sclerae
- CT: Dilated bile duct with potential sludge/stones
- ERCP: Multiple irregular defects in biliary tree
- Treatment: Biliary sphincterotomy, blood clot extraction, plastic stent insertion (removed after 4 weeks)
About Hemobilia:
- Causes: Primary cancer, trauma, gallstones, liver biopsy, etc.
- Indicators (Quinke's triad): Epigastric pain, jaundice, gastrointestinal bleeding (not always all three)
- Diagnosis: Endoscopy, CT imaging, ERCP with cholangiography
- Treatment: Biliary tree decompression, drainage, blood transfusion if needed, address underlying cause

Conclusion: Hemobilia, though rare, can be a severe post-procedure complication, requiring prompt diagnosis and effective treatment.

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