Recurrent gastrointestinal bleeding and hepatic infarction after liver biopsy

Abstract

Hepatic artery pseudoaneurysms (HAP) are rare events, particularly after liver biopsy, but can be associated with serious complications. Therefore a high suspicion is necessary for timely diagnosis and appropriate treatment. We report on a case of HAP that potentially formed after a liver biopsy in a patient with sarcoidosis. The HAP in our case was virtually undetectable initially by angiography but resulted in several complications including recurrent gastrointestinal bleeding, hemorrhagic cholecystitis and finally hepatic infarction with abscess formation until it became detectable at a size of 5-mm. The patient remains asymptomatic over a year after endovascular embolization of the HAP. In this report, we demonstrate that a small HAP can avoid detection by angiography at an early stage while being symptomatic for a prolonged course. A high clinical suspicion with a close clinical/radiological follow-up is needed in symptomatic patients with history of liver biopsy despite initial negative work up. Once diagnosed, HAP can be safely and effectively treated by endovascular embolization.

Keywords: Gastrointestinal bleed, Abnormal liver enzymes, Hepatic artery pseudoaneurysms, Liver biopsy, Angiography

Core tip: We describe a case of a 43-year-old woman with a small hepatic artery pseudoaneurysm (HAP) that was persistently symptomatic and avoided radiographic detection at an early stage. High clinical suspicion and close clinical/radiological follow-up is required for patients with risk factors such as previous liver biopsy, even if an initial workup is negative. These small HAPs may cause symptoms as late as several weeks after a liver biopsy, and have the potential to afflict severe complications such as hemobilia and thrombosis of the hepatic artery branches, resulting in hepatic infarction and abscess formation.