Acute biliary-vascular fistula following needle aspiration of the liver.
A patient with cavernous transformation of the portal vein and a suspected hepatic mass lesion underwent an ultrasound-guided aspiration of the liver with a skinny needle. Two days later he became acutely ill. Bilirubin level peaked at 1375 mumol/L (80.4 mg/dL), and alkaline phosphatase level was 2290 IU/mL. There was no evidence of biliary obstruction. A biliary-vascular fistula was diagnosed by endoscopic retrograde cholangiography, and nasobiliary drainage was placed, leading to resolution of the symptoms and jaundice. A pressure gradient between the biliary tree and a venous collateral probably led to flow of bile into a blood vessel. Nasobiliary drainage should be considered as a potential therapy for acute biliary-vascular fistula.
Verhille
M S
MS
Department of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania.
Muñoz
S J
SJ
D000208:Acute Disease; D000328:Adult; D001658:Biliary Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D001707:Biopsy, Needle / Q000009:adverse effects*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage; D005402:Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy