Published: 2021-12-24

Massive hemorrhage after percutaneous liver biopsy in a pediatric patient with graft-versus-host disease; a successful angiographic embolization

Mustafa Okumuş, Utku Alkara, Barış Malbora, Hakan Sarbay, Fulya Kamit


Most cases of bleeding that develop after percutaneous liver biopsies can be managed with follow-up and supportive treatment. In life-threatening situations, however, open surgery or minimally invasive methods are required. This case report describes the clinical course of an 11-year-old patient with a diagnosis of Wiskott-Aldrich syndrome who experienced a major hemorrhage following a percutaneous liver biopsy. Clinical findings, imaging, interventions, and results were evaluated. Allogeneic hematopoietic stem cell transplantation was performed without any problem. The patient's bilirubin level started to increase on the 20th day after transplantation. Profuse watery diarrhea started on the 24th day. Graft-versus-host disease of the gastrointestinal tract and liver was considered as his diarrhea continued to the 29th day. An ultrasound-guided Tru-cut® liver biopsy (Merit medical, South Jordan, UT, USA) was performed with an 18-gauge needle on the 52nd day after transplantation. In the fourth hour after the procedure, the general condition of the patient started to deteriorate. Active bleeding was detected in the patient with computed tomography, and he was hypotensive and tachycardic. The patient was urgently transferred to the angiography unit and a successful angiographic embolization was performed. Angiographic embolization is an intervention with high success rates in cases of bleeding where the patient is hemodynamically stable. However, it can also be successfully applied in selected patients who are hemodynamically unstable.


Percutaneous liver biopsy, Hemorrhage, Angiographic embolization, Pediatrics, Stem cell transplantation

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