Bile leak after transjugular liver biopsy in a cholecystectomy patient

Transjugular liver biopsy (TJLB) is a minimally invasive procedure performed to obtain hepatic tissue in patients whom standard percutaneous liver biopsy is contraindicated due to abnormal coagulation profile and/or severe ascites. Additionally, it has the advantage of simultaneously measuring the hepatic venous pressures.

61-year-old male with history of pulmonary fibrosis, cholecystectomy and Hepatitis C underwent transjugular liver biopsy (TJLB) as part of his lung transplant workup. Shortly after the procedure, the patient developed sharp right upper abdominal pain. Immediate CT of the abdomen and pelvis showed small foci of contrast and gas in the gallbladder fossa and porta hepatis indicating hepatic capsular penetration without perihepatic hematoma or other evidence of hemorrhage. Follow up CT of the abdomen and HIDA scan confirmed the presence of bile leak. Sphincterotomy and stent placement through ERCP was performed.

Bile leak after a TJLB is a rare, however, potential complication. ERCP and biliary stent seems an effective treatment for persistent symptomatic bile leak post TJLB.