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

Authors

  • Mustafa Okumuş Department of Pediatric Surgery, Yeni Yüzyıl University, Faculty of Medicine, İstanbul, Turkey http://orcid.org/0000-0001-8705-5183
  • Utku Alkara Department of Radiology, Yeni Yüzyıl University, Faculty of Medicine, İstanbul, Turkey
  • Barış Malbora Department of Pediatric Hematology, Yeni Yüzyıl University, Faculty of Medicine, İstanbul, Turkey
  • Hakan Sarbay Department of Pediatric Oncology, Yeni Yüzyıl University, Faculty of Medicine, İstanbul, Turkey
  • Fulya Kamit Department of Pediatric Intensive Care, Yeni Yüzyıl University, Faculty of Medicine, İstanbul, Turkey

DOI:

https://doi.org/10.18203/2349-3291.ijcp20214949

Keywords:

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

Abstract

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.

Author Biography

Mustafa Okumuş, Department of Pediatric Surgery, Yeni Yüzyıl University, Faculty of Medicine, İstanbul, Turkey

Department of Pediatric Surgery

References

Dezsőfi A, Baumann U, Dhawan A, Durmaz O, Fischler B, Hadzic N et al. ESPGHAN Hepatology Committee. Liver biopsy in children: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr. 2015;60:408-20.

Neuberger J, Patel J, Caldwell H, Davies S, Hebditch V, Hollywood C et al. Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology. Gut. 2020; 69:1382-403.

Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med. 2001;344:495-500.

Quezada N, León F, Martínez J, Jarufe N, Guerra JF. Emergency right hepatectomy after laparoscopic tru-cut liver biopsy. Int J Surg Case Rep. 2015;8:42-4.

Gates RL, Price M, Cameron DB, Somme S, Ricca R, Oyetunji TA et al. Non-operative management of solid organ injuries in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review. J Pediatr Surg. 2019;54:1519-26.

Van As AB, Millar AJ. Management of paediatric liver trauma. Pediatr Surg Int. 2017;33:445-53.

Kiankhooy A, Sartorelli KH, Vane DW, Bhave AD. Angiographic embolization is safe and effective therapy for blunt abdominal solid organ injury in children. J Trauma. 2010; 68:526-31.

Virdis F, Reccia I, Di Saverio S, Tugnoli G, Kwan SH, Kumar J et al. Clinical outcomes of primary arterial embolization in severe hepatic trauma: A systematic review. Diagn Interv Imaging. 2019;100:65-75.

Gilyard S, Shinn K, Nezami N, Findeis LK, Dariushnia S, Grant AA et al. Contemporary Management of Hepatic Trauma: What IRs Need to Know. Semin Intervent Radiol. 2020;37:35-43.

Iida A, Ryuko T, Kemmotsu M, Ishii H, Naito H, Nakao A. Three-year-old traumatic liver injury patient treated successfully using transcatheter arterial embolization. Int J Surg Case Rep. 2020;70:205-8.

Ohtsuka Y, Iwasaki K, Okazumi S, et al; Management of blunt hepatic injury in children: usefulness of emergency transcatheter arterial embolization. Pediatr Surg Int. 2003;19:29-34.

Temiz A, Gedikoğlu M, Ezer SS, Oğuzkurt P, Hiçsönmez A. Endovascular Diagnosis and Successful Treatment of Massive Gastrointestinal Hemorrhage in Children. Balkan Med J. 2018;35:404-5.

Puapong D, Brown CV, Katz M, Kasotakis G, Applebaum H, Salim A et al. Angiography and the pediatric trauma patient: a 10-year review. J Pediatr Surg. 2006;41:1859-63.

Van der Vlies CH, Saltzherr TP, Wilde JC, van Delden OM, De Haan RJ, Goslings JC. The failure rate of nonoperative management in children with splenic or liver injury with contrast blush on computed tomography: a systematic review. J Pediatr Surg. 2010;45:1044-9.

Downloads

Published

2021-12-24

Issue

Section

Case Reports