Liver biopsies are collected to aid in diagnosis of liver disease and staging of fibrosis, but complications can include pain, bleeding, puncture of another organ, and rare events such as biliary peritonitis, sepsis and shock, bilious pleural effusion, pseudoaneurysm of intercostal artery, and fragmentation of the biopsy needle.
Nicole Boschuetz et al report the case of a 64-year-old woman who had 25 days of dull constant right upper quadrant abdominal pain that began 1 day after a percutaneous liver biopsy. She had previously undergone cholecystectomy and sphincterotomy for reported sphincter of Oddi dysfunction.
Her liver biopsy was performed for increased levels of liver enzymes, but she was not taking any known hepatotoxic agents. The biopsy showed mild chronic lobular hepatitis with stage 1 fibrosis.
A physical exam revealed only mild right upper quadrant and epigastric abdominal tenderness without rebound or guarding. Yet tests revealed worsening liver function.
An ultrasound showed no evidence of free fluid or hepatic hematoma. However, computed tomography revealed a new thrombus in the posterior branch of the right portal vein with geographic hypoattenuation of liver segments 5, 6, and 7 (see arrow in Figure). Boschuetz et al suspected the likely cause of the thrombus was damage to a small branch of portal vein during biopsy, because of the location of the thrombus and timing after biopsy. The patient was managed conservatively, results from liver tests returned to baseline, and her pain resolved.
Boschuetz et al explain that although mortality from complications of liver biopsy is below 0.4%, they can lead to additional tests, procedures, and hospitalizations. Most complications are noted within 24 hours of procedure. Because of the frequency of percutaneous liver biopsies, it is important to be aware of serious complications that might require specific tests.