Lin Chih-Lang, Chang Jia-Jang, Lee Tsung-Shih, Lui Kar-Wai, Yen Cho-Li
Division of Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital and University, Keelung, Taiwan, China.
World J Gastroenterol. 2005 Jan 14;11(2):305-7. doi: 10.3748/wjg.v11.i2.305.
Outpatient percutaneous liver biopsy is a common practice in the differential diagnosis and treatment of chronic liver disease. The major complication and mortality rate were about 2-4% and 0.01-0.33% respectively. Arterio-portal fistula as a complication of percutaneous liver biopsy was infrequently seen and normally asymptomatic. Hemobilia, which accounted for about 3% of overall major percutaneous liver biopsy complications, resulted rarely from arterio-portal fistula We report a hemobilia case of 68 years old woman who was admitted for abdominal pain after liver biopsy. The initial ultrasonography revealed a gallbladder polypoid tumor and common bile duct (CBD) dilatation. Blood clot was extracted as endoscopic retrograde cholangiopancreatography (ERCP) showed hemobilia. The patient was shortly readmitted because of recurrence of symptoms. A celiac angiography showed an intrahepatic arterio-portal fistula. After superselective embolization of the feeding artery, the patient was discharged uneventfully. Most cases of hemobilia caused by percutaneous liver biopsy resolved spontaneously. Selective angiography embolization or surgical intervention is reserved for patients who failed to respond to conservative treatment.
门诊经皮肝穿刺活检是慢性肝病鉴别诊断和治疗中的常见操作。主要并发症发生率和死亡率分别约为2% - 4%和0.01% - 0.33%。肝动脉门静脉瘘作为经皮肝穿刺活检的并发症较为少见，通常无症状。胆道出血约占经皮肝穿刺活检主要并发症的3%，很少由肝动脉门静脉瘘引起。我们报告一例68岁女性在肝穿刺活检后因腹痛入院的胆道出血病例。最初的超声检查显示胆囊息肉样肿物和胆总管扩张。由于内镜逆行胰胆管造影（ERCP）显示胆道出血，故取出血凝块。患者因症状复发不久后再次入院。腹腔血管造影显示肝内肝动脉门静脉瘘。在对供血动脉进行超选择性栓塞后，患者顺利出院。大多数经皮肝穿刺活检引起的胆道出血病例可自行缓解。对于保守治疗无效的患者，可考虑选择性血管造影栓塞或手术干预。
