Acute hemobilia following computed tomography-guided percutaneous liver biopsy: A case report

doi:10.4254/wjh.125241

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Case Report

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Hepatol. Oct 27, 2026; 18(10): 125241
Published online Oct 27, 2026. doi: 10.4254/wjh.125241

Acute hemobilia following computed tomography-guided percutaneous liver biopsy: A case report

Yong-Chao Xu, Tangnuran Halimulati, Xiao-Feng Yu, Xia-Xin Guo, Dan-Dan Zhao, Jing-Wang Bi, Qiang Wang

Yong-Chao Xu, Tangnuran Halimulati, Dan-Dan Zhao, Jing-Wang Bi, Qiang Wang, Department of Oncology, Shandong Second Provincial General Hospital, Jinan 250023, Shandong Province, China

Xiao-Feng Yu, Xia-Xin Guo, Qiang Wang, Clinical Medicine Research Center, Shandong Second Provincial General Hospital, Jinan 250023, Shandong Province, China

Co-first authors: Yong-Chao Xu and Tangnuran Halimulati.

Co-corresponding authors: Jing-Wang Bi and Qiang Wang.

Author contributions: Xu YC and Halimulati T wrote the original draft, and they contributed equally to this work as co-first authors; Bi JW and Wang Q contributed equally to this work as co-corresponding authors; Xu YC, Halimulati T, Bi JW, and Wang Q designed the research study and provided study materials or patients; Xu YC, Halimulati T, Yu XF, Guo XX, and Zhao DD collected and assembled data; Xu YC, Halimulati T, Zhao DD, Bi JW, and Wang Q reviewed and edited the manuscript; Xu YC, Bi JW, and Wang Q supervised the study; all authors approved the final version of the manuscript and are accountable for all aspects of the work.

AI contribution statement: AI tools, specifically Gemini3.1, were used solely for language polishing and formatting assistance. No AI tool was used to generate research data, interpret results, or formulate conclusions. All AI-assisted content was critically reviewed and revised by the authors, who take full responsibility for the accuracy, originality, and integrity of the manuscript.

Supported by Taishan Scholar Foundation of Shandong Province, No. tsqn202312378; National Natural Science Foundation of China, No. 81972793; and Traditional Chinese Medicine Science and Technology Foundation of Shandong Province, No. Q-2023037.

Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Qiang Wang, MD, PhD, Department of Oncology, Shandong Second Provincial General Hospital, No. 4 Duanxing West Road, Huaiyin District, Jinan 250023, Shandong Province, China. wangqiang@sdent.com.cn

Received: July 7, 2026
Revised: August 3, 2026
Accepted: September 15, 2026
Published online: October 27, 2026
Processing time: 106 Days and 18.1 Hours

Abstract

BACKGROUND

Acute hemobilia is an uncommon complication of computed tomography (CT)-guided percutaneous liver biopsy.

CASE SUMMARY

We report a 57-year-old man with colorectal liver metastases. He underwent biopsy due to disease progression after multiple lines of anticancer therapy, including antiangiogenic agents and chimeric antigen receptor T-cell therapy. During stepwise withdrawal of the coaxial cannula, he suddenly developed severe right upper quadrant pain, diaphoresis, nausea, sinus tachycardia, and a positive Murphy’s sign. Immediate non-contrast CT revealed marked gallbladder distention and new hyperattenuating contents compared with preprocedural imaging. Acute hemobilia was diagnosed based on the timing of symptom onset, clinical findings, and CT features. His symptoms resolved with conservative management. Previous therapies may have contributed to the endothelial injury and microvascular fragility, while loss of the tamponade effect during cannula withdrawal may have allowed bleeding into an injured biliary structure.

CONCLUSION

Prophylactic gelatin sponge tract embolization warrants consideration when suspected microvascular fragility coexists with technically complex biopsy.

Keywords: Arteriobiliary fistula; Hemobilia; Mechanical tamponade effect; Percutaneous liver biopsy; Tract embolization; Case report

Core Tip: We report a case of a heavily pretreated patient who developed acute hemobilia during coaxial cannula withdrawal after computed tomography-guided liver biopsy. Immediate non-contrast computed tomography and physical signs enabled prompt diagnosis. Loss of mechanical tamponade and possible treatment-related vascular vulnerability were considered plausible, although they are unconfirmed contributing factors. In selected cases, prophylactic gelatin sponge tract embolization during coaxial cannula withdrawal may be considered a reasonable preventive option.