[Prognosis of the bleeding as a complication of percutaneous thick needle biopsy of the liver].
Bleeding after biopsy of the liver (LB) is a rare event, hard to prognose and occurs frequently in those cases, when we do not expect it. Bleeding is the main reason of complications and deaths subsequent to LB. The aim of the study was to prognose the bleeding on the basis of hemodynamic disturbances and clinical symptoms occurring just after LB.


METHODS
The study was performed on 145 patients with LB. The blood pressure and heart rate were examined before and after procedure of biopsy. In the group of 142 patients without bleeding complications, circulating disturbances and clinical symptoms were compared with three patients of bleeding subsequent to LB. The patients with bleeding were analyzed retrospectively.


RESULTS
In the group of patients without bleeding complications after LB there was observed statistically significant reduction of blood pressure. In 29 cases (46%) bradycardia occurred, in 15 cases (23.8%) clinical symptoms of vasovagal syndrome were noticed. Pain at the needle insertion site and shoulder pain happened in 15 (10.6%) patients. In one patient with low hypotension the pain was intense and localized in the whole abdominal cavity. In two cases with bleeding the hypotension occurred in 6th and 7th hour with the heart rate 60-70/min and in the third case the massive bleeding led to the shock.


CONCLUSIONS
Hemodynamic disturbances including hypotension and bradycardia are frequent and difficult to diagnose. Bradycardia does not differentiate vasovagal reaction after LB with hypotension caused by bleeding. Coincidence of hypotension with abdominal pain indicates the high probability of bleeding subsequent to LB. Ultrasound examination of the abdomen is highly useful in the confirmation of bleeding complications.
Cieśla
Andrzej
A
Katedry i Kliniki Chorób Zakaźnych i Hepatologii, Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie.
Mach
Tomasz
T
Szczepański
Wojciech
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000009:adverse effects / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007022:Hypotension / Q000453:epidemiology; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies