Presentation
Renal failure with worsening hepatic enzymes. A liver biopsy requested to identify the cause.
Patient Data
Dual phase CT Liver: extravasation of contrast from segment 4B of the liver (at the site of the earlier performed ultrasound guided liver biopsy).
Moderate volume high attenuation fluid in the abdomen and pelvis, in keeping with a hemoperitoneum.
Case Discussion
Ultrasound guided biopsy of the liver is a commonly performed procedure, with clinically significant post-procedural hemorrhage thankfully uncommon.
The lessons from this case are:
1. Never be complacent (this is only the 3rd, but the worst hemorrhage of many hundred liver biopsies I have performed).
2. Follow pre-preparation protocols rigourously, although it doesnt mean hemorrhage will never happen (this was a single pass, non-focal biopsy).
3. Post-procedural care from radiological procedures on return to the ward is vital.
The patient stablised, without the need for embolization or surgery.
Ultimately the procedure helped the patient in that a treatable cause for his hepatic impairment was identified - herpes simplex hepatitis.
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