Case Report
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World J Gastroenterol. Feb 21, 2014; 20(7): 1878-1881
Published online Feb 21, 2014. doi: 10.3748/wjg.v20.i7.1878
Recurrent gastrointestinal bleeding and hepatic infarction after liver biopsy
Faraz Bishehsari, Peng-Sheng Ting, Richard M Green
Faraz Bishehsari, Richard M Green, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, United States
Peng-Sheng Ting, Department of Medicine, National Taiwan University College of Medicine, No. 1 Jen Ai Road Section 1, Taipei 10051, Taiwan
Author contributions: All authors participated in the patient care, literature review and preparing the manuscript.
Correspondence to: Faraz Bishehsari, MD, PhD, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Lurie 3-250, 303 East Superior Street, Chicago, IL 60611, United States. faraz-bishehsari@fsm.northwestern.edu
Telephone: +1-312-5031837 Fax: +1-312-5032576
Received: July 18, 2013
Revised: September 2, 2013
Accepted: September 16, 2013
Published online: February 21, 2014
Processing time: 237 Days and 10.6 Hours
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.