Pseudoaneurysm formation after ultrasound-guided liver biopsy in an obese child

Pseudoaneurysm formation is a rare complication of percutaneous liver biopsy, the incidence of which can be reduced by using ultrasound (US) guidance. We describe an obese 11-year-old male who underwent US-guided liver biopsy for persistently elevated transaminases. He subsequently developed anemia, melena, and hemobilia as noted on esophagogastroduodenoscopy. He was found to have a pseudoaneurysm with an arterial-biliary fistula as well as pancreatitis from bleeding into the common bile duct. Although US-guided liver biopsies are safe procedures to perform in children, complications can occur and should be considered in any child with anemia after biopsy, especially in association with hemobilia.