An Intraluminal Gallbladder and Bile Duct Hematoma after a Percutaneous Biopsy of Hepatic Adenoma

경피 간 생검 후 담도 및 담낭내 혈종이 발생한 간선종 1예

  • Song, Hyun-Jung (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Choi, Young-Woo (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Park, Joo-Ho (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Lee, Tae-Hee (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Kim, Yong-Seok (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Kang, Young-Woo (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Choi, In-Seok (Department of General Surgery, Konyang University College of Medicine)
  • 송현정 (건양대학교 의과대학 내과학교실) ;
  • 최용우 (건양대학교 의과대학 내과학교실) ;
  • 박주호 (건양대학교 의과대학 내과학교실) ;
  • 이태희 (건양대학교 의과대학 내과학교실) ;
  • 김용석 (건양대학교 의과대학 내과학교실) ;
  • 강영우 (건양대학교 의과대학 내과학교실) ;
  • 최인석 (건양대학교 의과대학 외과학교실)
  • Published : 2011.03.01

Abstract

Hepatocellular adenoma is a rare, but benign, tumor mostly found in women taking oral contraceptives. Hepatocellular adenoma must be treated when bleeding of the tumor, intraperitoneal hemorrhage, or malignant transformation occurs. A percutaneous liver biopsy is relatively safe and effective, but carries the risk of mild complications, such as pain, temporary hypotension, and bleeding, and severe complications, such as intraperitoneal bleeding, peritonitis, pneumothorax, hemothorax, other organ injury, and sepsis. We treated a 33-year-old woman with hemobilia and gallbladder hematoma following a sono-guided percutaneous liver biopsy. Complete quadrantectomy with anterior lobe resection was done after angiography and embolization of the hepatic artery.

간선종은 피임약을 복용하는 여성에게 호발하는 것으로 알려져 있으나, 본 예에서는 피임약을 복용하지 않은 젊은 가임기 여성에서 큰 간종괴로 조직검사 후 혈액담즙증 및 담낭내 혈종이 발생하여 간동맥 색전술을 시행하고, 조직검사상 진단된 간선종을 수술한 1예를 보고하는 바이다.

Keywords

References

  1. Klatskin G. Hepatic tumors; possible relationship to use of oral contraceptives. Gastroenterology 1977;73:386-394.
  2. Rooks JB, Ory HW, Ishak KG, et al. Epidemiology of hepatocellular adenoma: the role of oral contraceptive use. JAMA 1979;242:644-648. https://doi.org/10.1001/jama.1979.03300070040020
  3. Okuda K, Kojiro M, Okuda H. Neoplasms of the liver. In: Schiff L, Schiff ER, eds. Diseases of the liver. 7th ed. Philadelphia: J.B. Lippincott, 1993:1236-1296.
  4. Leese T, Farges O, Bismuth H. Liver cell adenomas: a 12-year surgical experience from a specialist hepato-biliary unit. Ann Surg 1988;208:558-564. https://doi.org/10.1097/00000658-198811000-00003
  5. International Working Party. Terminology of nodular hepatocellular lesions. International Working Party. Hepatology 1995;22: 983-993.
  6. Colovic R, Grubor N, Micev M, Radak V. Hepatocellular adenoma with malignant alteration. Hepatogastroenterology 2007; 54:386-388.
  7. Chuang WY, Chen TC, Hsu HL, Lee WC, Jeng LB, Huang SF. Liver cell adenoma with concomitant hepatocellular carcinoma: report of two cases. J Formos Med Assoc 2002;101:798-802.
  8. Choe MS, Yu ES. Hepatocellular carcinoma arising in hepatocellular adenoma. Korean J Hepatol 2002;8:107-109.
  9. Kim DH, Kim SU, Nam DH, et al. A case of hepatocellular carcinoma within hepatocellular adenoma in a non-cirrhotic male. Korean J Intern Med 2009;24:147-152. https://doi.org/10.3904/kjim.2009.24.2.147
  10. Lewis R. Liver and Biliary Tract Tumors: Cecil Textbook of Medicine. 23th ed. WB Saunders, 2007.
  11. Kang SJ, Lee OJ, Jung KW, et al. A case of hepatocellular adenoma not associated with oral contraceptive in woman. Korean J Gastroenterol 2001;38:444-448.
  12. Kim CM, Lee JH, Lee HS, Kim CY, Park JH, Kim YI. A case of multiple hepatocellular adenoma in adult male. Korean J Gastroenterol 1990;22:477-483.
  13. Piccinino F, Sagnelli E, Pasquale G, Giusti G. Complications following percutaneous liver biopsy: a multicentre retrospective study on 68,276 biopsies. J Hepatol 1986;2:165-173. https://doi.org/10.1016/S0168-8278(86)80075-7
  14. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001;344:495-500. https://doi.org/10.1056/NEJM200102153440706
  15. Perrault J, McGill DB, Ott BJ, Taylor WF. Liver biopsy: complications in 1000 inpatients and outpatients. Gastroenterology 1978; 74:103-106.
  16. Moon W, Sohn JH, Jang MH, et al. A case of acute cholecystitis secondary to hemobilia after percutaneous liver biopsy. Korean J Gastroenterol 2006;47:72-76.
  17. Lee SH, Kim TN, Lee JY, Moon HJ, Park YS, Choi JW. A case of acute cholangitis with intraluminal gallbladder hematoma after percutaneous liver biopsy. Korean J Gastrointest Endosc 2007; 35:277-280.
  18. Choi SP, Kim TH, Lee WH, et al. A case of intraluminal gallbladder hematoma and subsequent cholecystitis after percutaneous liver biopsy. Korean J Med 2009;76:74-77.
  19. Ferrell LD. Hepatocellular carcinoma arising in a focus of multilobular adenoma: a case report. Am J Surg Pathol 1993;17: 525-529. https://doi.org/10.1097/00000478-199305000-00013
  20. Grazioli L, Federle MP, Brancatelli G, Ichikawa T, Olivetti L, Blachar A. Hepatic adenomas: imaging and pathologic findings. Radiographics 2001;21:877-892; discussion 892-894.