Delayed hemorrhage after percutaneous liver biopsy. Role of therapeutic angiography

J Clin Gastroenterol. 1994 Jul;19(1):50-3. doi: 10.1097/00004836-199407000-00013.

Abstract

We report a patient on warfarin prophylaxis who had major intraperitoneal hemorrhage 17 days following percutaneous liver biopsy (PLBx). Selective hepatic angiography revealed a pseudoaneurysm of a branch of the right hepatic artery, associated with an arterio-portal venous fistula. Ultrasound with Doppler studies showed flow through the pseudoaneurysm. Embolization with platinum micro-coils resulted in cessation of flow through the pseudoaneurysm, and closure of the arterio-portal venous fistula. Anticoagulation was then resumed without recurrent bleeding. Pseudoaneurysms and arteriovenous fistulas may be mechanisms by which delayed bleeding occurs after PLBx. Doppler ultrasonography and hepatic angiography are useful in the evaluation and management of this event.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aneurysm, False / etiology
  • Aneurysm, False / therapy
  • Arteriovenous Fistula / etiology*
  • Arteriovenous Fistula / therapy
  • Biopsy, Needle / adverse effects*
  • Embolization, Therapeutic*
  • Hematoma / etiology*
  • Hepatic Artery / injuries*
  • Humans
  • Liver Diseases / etiology*
  • Liver Diseases / therapy
  • Male
  • Portal Vein / injuries*
  • Time Factors
  • Warfarin / therapeutic use

Substances

  • Warfarin