title: Gallbladder polyp as a manifestation of hemobilia caused by arterial-portal fistula after percutaneous liver biopsy: a case report.
abstract: 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.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital and University, Keelung, Taiwan, China.
authors.forename: Chih-Lang
authors.initials: CL
authors.lastname: Lin
authors.forename: Jia-Jang
authors.initials: JJ
authors.lastname: Chang
authors.forename: Tsung-Shih
authors.initials: TS
authors.lastname: Lee
authors.forename: Kar-Wai
authors.initials: KW
authors.lastname: Lui
authors.forename: Cho-Li
authors.initials: CL
authors.lastname: Yen
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D001707:Biopsy, Needle / Q000009:adverse effects*; D005260:Female; D005402:Fistula; D005705:Gallbladder Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D006431:Hemobilia / Q000209:etiology* / Q000601:surgery; D006499:Hepatic Artery / Q000473:pathology* / Q000601:surgery; D019698:Hepatitis C, Chronic / Q000473:pathology; D006801:Humans; D011127:Polyps / Q000000981:diagnostic imaging / Q000209:etiology*; D011169:Portal Vein / Q000473:pathology* / Q000601:surgery; D014463:Ultrasonography