Fístula portobiliar como complicación mayor de biopsia hepática transpercutánea bajo marcación ecográfica

Woman of 71 years, in study of chronic liver disease, Child-Pugh A, computed tomography (CT) suggestive of cirrhosis, autoimmune hepatitis score probable. It was decided to perform a liver percutaneous biopsy for diagnosis and treatment. After the procedure, the patient presented a self-limited episode of hematemesis. Upper digestive endoscopy without blood or other injury, abdominal ultrasound without free liquid. The patient was hospitalized, evolving hemodynamically stable without new bleeding episodes. Medical discharge was decided after 24 hours of observation. The patient consults the next day at emergency room because of intense abdominal pain and anemia. CT Impressed a dilated bile duct with hyperdense content inside, so she was rehospitalized. The patient evolved with melaena and hypotension. Biliary hematoma due to arteriobiliary fistula was suspected. CT angiogram evidenced portobiliary fistula. It was managed with endovascular therapy but the patient remained hypotense with a requirement for vasoactive drugs and multi-organ dysfunction, and she finally died.