Huang Jia-Yan, Lu Qiang, Liu Ji-Bin
Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China Department of Ultrasound/Radiology, Thomas Jefferson University, Philadelphia, PA.
Medicine (Baltimore). 2018 Mar;97(9):e9955. doi: 10.1097/MD.0000000000009955.
Hemorrhage, one of complications after liver biopsy, is often identified immediately after the procedure while delayed liver rupture is relatively rare.
A 45-year-old woman was diagnosed with undetermined liver cirrhosis and abnormal liver function. To determine the etiology and severity of liver cirrhosis, ultrasound-guided liver biopsy was arranged. The patients did not complain any pain during the procedure. Ultrasound examination on postoperative day1 (POD 1) and MRI on POD 3 showed no evidence of hematoma and ascites. On POD 7, however, the patient was taken to the hospital with a sudden onset of pain in the right upper quadrant of the abdomen.
Contrast-enhanced computed tomography revealed liver rupture of right inferior segment of the liver with subcapsular hematoma.
Patient was treated with infusion of 2-unit red blood cell suspension, fluid and hemostatics.
The vital signs of the patient were stabilized after the therapy. The follow-up ultrasound 1 month later showed a shrunken subcapsular hematoma measuring 4.2 × 2.1 cm at the right lobe.
Whenever a liver biopsy procedure is performed, the care should be taken to avoid puncturing those areas that may have liver incisure. Moreover, the patient need to rest for several days and to avoid heavy activities, which is one of the major risk factors for post-procedure bleeding.
出血是肝活检后的并发症之一，通常在操作后立即被发现，而延迟性肝破裂相对少见。
一名45岁女性被诊断为不明原因肝硬化及肝功能异常。为明确肝硬化的病因及严重程度，安排了超声引导下肝活检。操作过程中患者未诉任何疼痛。术后第1天（POD 1）超声检查及POD 3磁共振成像均未显示血肿及腹水迹象。然而，在POD 7时，患者因右上腹突发疼痛被送往医院。
增强计算机断层扫描显示肝右叶下段破裂伴包膜下血肿。
患者接受了2单位红细胞悬液、液体及止血药物的输注治疗。
治疗后患者生命体征稳定。1个月后的随访超声显示右叶包膜下血肿缩小，大小为4.2×2.1 cm。
进行肝活检操作时，应注意避免穿刺可能存在肝裂的区域。此外，患者需要休息数日并避免剧烈活动，这是术后出血的主要危险因素之一。
