title: Emergency right hepatectomy after laparoscopic tru-cut liver biopsy.
abstract: BACKGROUND
  Liver biopsy is a common procedure usually required for final pathologic diagnosis of different liver diseases. Morbidity following tru-cut biopsy is uncommon, with bleeding complications generally self-limited. Few cases of major hemorrhage after liver biopsies have been reported, but to our knowledge, no cases of emergency hepatectomy following a tru-cut liver biopsy have been reported previously.
  
  
  METHODS
  We report the case of a 38 years-old woman who presented with an intrahepatic arterial bleeding after a tru-cut liver biopsy under direct laparoscopic visualization, initially controlled by ligation of the right hepatic artery and temporary liver packing. On tenth postoperative day, she developed a pseudo-aneurysm of the anterior branch of the right hepatic artery, evolving with massive bleeding that was not amenable to control by endovascular therapy. Therefore, an emergency right hepatectomy had to be performed in order to stop the bleeding. The patient achieved hemodynamic stabilization, but developed a biliary fistula from the liver surface, refractory to non-operative treatment. In consequence, a Roux-Y hepatico-jejunostomy was performed at third month, with no further complications.
  
  
  CONCLUSIONS
  Bleeding following tru-cut biopsy is a rare event. To our knowledge, this is the first report of an emergency hepatectomy due to hemorrhage following liver biopsy. Risks and complications of liver biopsy are revised.
  
  
  CONCLUSIONS
  Care must be taken when performing this kind of procedures and a high level of suspicion regarding this complication should be taken in count when clinical/hemodynamic deterioration occurs after these procedures.
authors.affiliation: Hepato-Pancreato-Biliary Unit, Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, Patio Interior, Postal Code: 8320000 Santiago, Chile.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Quezada
authors.affiliation: Hepato-Pancreato-Biliary Unit, Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, Patio Interior, Postal Code: 8320000 Santiago, Chile.
authors.forename: Felipe
authors.initials: F
authors.lastname: León
authors.affiliation: Hepato-Pancreato-Biliary Unit, Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, Patio Interior, Postal Code: 8320000 Santiago, Chile.
authors.forename: Jorge
authors.initials: J
authors.lastname: Martínez
authors.affiliation: Hepato-Pancreato-Biliary Unit, Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, Patio Interior, Postal Code: 8320000 Santiago, Chile.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Jarufe
authors.affiliation: Hepato-Pancreato-Biliary Unit, Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, Patio Interior, Postal Code: 8320000 Santiago, Chile. Electronic address: jfguerra@med.puc.cl.
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Guerra
keywords: Emergency hepatectomy; Liver biopsy; Tru-cut