This case involves a fifty-five-year-old male with a medical history of Hepatitis C and a prior liver transplant. Less than one year after the successful transplant surgery, the patient started to experience increased signs and symptoms of illness, which prompted physicians to do a full workup surrounding the liver. In order to make a diagnosis, this included an ERCP and a liver biopsy. As a result of the biopsy, the patient suffered a massive hematoma and required a second liver transplant.
Question(s) For Expert Witness
- 1. Is this a common complication after liver biopsy and if so, what is the usual intervention?
Expert Witness Response E-000589
Bleeding comprises the second most common complication for liver biopsy after overt pain. Presentations include subcapsular or parenchymal hematoma, hemobilia, or free intraperitoneal hemorrhage. Intrahepatic or subcapsular hematomas are the most common of the bleeding complications and are noted on approximately 23% of ultrasound images obtained following biopsy. Such findings often are incidental, without associated clinical symptoms. They occur at similar rates after either blind or laparoscopy-guided modalities, but incidence may be influenced by needle type and imaging technique. Large hematomas are a rare cause of biliary obstruction. Symptomatic hematomas should be imaged by ultrasound but usually respond to conservative treatment with analgesics. The fact that this patient required a second liver transplant was most likely due to other comorbid diseases or an underlying coagulation disturbance.