Hemoperitoneum after percutaneous liver biopsy; Videolaparoscopic management

Abstract

BACKGROUND: Percutaneous liver biopsy is a safe procedure, with a low rate of major complications. Among these massive hemoperitoneum is the most life threatening, and its management sometimes leads to an emergency invasive surgical approach.

CASE REPORT AND RESULTS: The following case highlights the possible role of laparoscopy in diagnosis and treatment of this condition. In this patient a significant intraperitoneal bleeding developed from a liver lesion 48 hours after needlebiopsy. Videolaparoscopic exploration evidenced a grade III laceration of the right lobe, successfully managed with coagulation and apposition of an absorbable haemostatic gauze. Peritoneal toilette and multiple drains completed the procedure. No surgical complications developed and the patient was discharged on 5th post-operative day.

DISCUSSION: Minimally invasive surgery has been, in this case, an adequate alternative for the treatment of this bleeding complication of liver biopsy, offering advantages in terms of low morbidity, quick recovery and satisfying cosmetic results.

CONCLUSIONS: Laparoscopy is gaining a prominent role in penetrating liver trauma, whenever conservative or angiographic management fails, and should be considered as the first surgical attempt especially in patients with stable hemodynamics despite active intraperitoneal bleeding.