Case Study: Arrest of Liver Haemorrhage Secondary to Percutaneous Liver Biopsy of a Haemangioma with Fibrin Glue

 

Published on MedED:  8 October 2020
Type of article: Clinical Article Summary

Compiler: Linda Ravenhill
Sources: Dixon, E.; Pasieka JL. HPB 2002, Volume 4, Number 4 175–177 doi: 10.1080/13651820260503837
  Haemorrhage resulting from blank and penetrating injury to the liver remains a difficult therapeutic problem. Packing of the peri-hepatic spaces to control bleeding has been well documented, as has the use of finger fracture techniques in hepatic trauma to allow vessel litigation in the haemodynamically stable patient.

This case study looked at the use of fibrin glue as a means of arresting traumatic haemorrhage from vascular tumours such as haemangiomas, with the conjunct consideration of using the intraparenchymal injection of fibrin glue to minimise bleeding for all percutaneous liver biopsies and liver trauma on the whole. 

The patient in the case study underwent a percutaneous liver biopsy of a solid mass in segment VI of the liver which was felt to be most in keeping with a hepatoma, but a haemangioma could not be ruled out. Following the procedure the patient experienced diffuse abdominal pain and became haemodynamically unstable. An emergency laparotomy revealed four litres of blood in the peritoneal cavity. Ongoing bleeding was determined from the biopsy site.  

A fibrin glue was injected into the site followed by ten minutes of manual compression, resulting in complete arrest of the haemorrhage. Post-op recovery was unevental.  

Based on this case study, it was put forward that that fibrin glue, injected down the tract of a penetrating injury could be a useful adjunct in liver trauma to arrest such haemorrhage; especially in an unstable patient who is not a candidate for finger fracture exploration of the injury tract. Further studies with fibrin glue, are needed to verify its safety.


Summary reproduced with kind permission from MedSpec Publishing.  
   

Contributor: Linda Ravenhill
Linda Ravenhill is a medical professional with an MA in Journalism. She has worked in the medical, technology and digital development spaces for over 25 years, & has a particular interest in the impact of technology on the delivery of healthcare in the Sub-Saharan Africa region.

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