GI Endoscopy · 1 min read
58-yo Patient Experiences Severe Hemobilia Post Liver Biopsy
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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