Potential Complications of Liver Biopsy
Liver biopsy procedures can lead to several serious complications including bleeding, pneumothorax, visceral perforation, and even death, with bleeding being the most common major complication occurring in approximately 0.5-1.0% of cases. 1
Major Complications
Bleeding Complications
- Hemorrhage is the most common serious complication, occurring in approximately 0.5% of cases, with rates varying based on patient risk factors 1
- Intraperitoneal hemorrhage (hemoperitoneum) can occur in 0.032-0.7% of cases 1
- Intrahepatic hematoma and hemobilia (bleeding into the biliary system) occur in approximately 0.006% of cases 1
- Hemothorax has been reported in 0.022-0.06% of cases 1
- Risk factors for bleeding include:
Respiratory Complications
- Pneumothorax can occur and is critical to recognize immediately due to potential for catastrophic outcomes if not promptly treated 1
- Symptoms include reduced breath sounds and typical radiographic findings 1
- Lung puncture has been reported in rare cases (0.014%) 1
Visceral Organ Perforation
- Perforation of adjacent organs including:
- Bile peritonitis can occur, especially in patients with biliary obstruction 1
Infectious Complications
- Infection occurs in approximately 0.1% of cases 1
- Can manifest as bacteremia, abscess formation, or sepsis 1, 2
- Risk is increased in post-transplant patients who underwent choledochojejunostomy 1
Mortality
- Death directly related to liver biopsy occurs in approximately 0.009-0.33% of cases 1, 3
- Mortality is usually related to hemorrhage 1
- Risk is higher in patients with malignancy (up to 12 per 1000 biopsies) 1
Minor Complications
- Pain at the biopsy site is common and usually mild 1
- Vasovagal reactions can occur during the procedure 4
- Minor bleeding that resolves spontaneously 1
- Hemobilia (blood in bile) can cause biliary colic, jaundice, or melena 2
- Neuralgia has been reported 1
Recognition and Management of Complications
Signs of Potential Complications
- Pain out of proportion to the procedure, especially severe or increasing abdominal pain, right shoulder pain, or chest pain 2
- Tachycardia and hypotension suggesting blood loss 2
- Excessive bright red bleeding from the puncture site 2
- Increasing abdominal distension 2
- Fever or signs of infection 2
Management Approach
- Close monitoring of vital signs every 15 minutes if bleeding is suspected 2
- Supportive care with large-caliber IV access, volume resuscitation, and blood transfusion as necessary 1, 2
- Angiographic embolization or surgery for patients with evidence of ongoing blood loss 1
- Pneumothorax may be self-limited but may require more aggressive intervention depending on severity 1
- Visceral perforation is usually managed expectantly, though surgical intervention may be needed for gallbladder puncture with persistent bile leak or secondary peritonitis 1
Risk Reduction Strategies
- Use of image guidance (ultrasound or CT) can reduce complication rates 1
- Platelet transfusion should be considered when levels are less than 50,000-60,000/mL 1
- Patients on chronic hemodialysis should be well dialyzed prior to liver biopsy, and heparin should be avoided 1
- Consider transjugular approach in patients with ascites, coagulopathy, or biliary obstruction 1
- Ensure patient cooperation during the procedure to prevent tearing of the liver and capsule 1
Special Considerations
- Delayed bleeding can occur up to one week after the procedure 2
- Complication rates are higher in patients with malignancy, cirrhosis, or other comorbidities 1
- The risk-benefit ratio must be carefully considered, especially in patients with extrahepatic biliary obstruction, bacterial cholangitis, or amyloidosis 1