# Hemobilia as a Complication of Transjugular Liver Biopsy Causing Acute Pancreatitis and Obstructive Jaundice: A Case Report and Minireview

## TL;DR

A rare case of hemobilia following a transjugular liver biopsy led to acute pancreatitis and jaundice, successfully treated with ERCP.

## Contribution

Highlights hemobilia as a rare complication of TJLB and its presentation with pancreatitis and jaundice rather than typical bleeding symptoms.

## Key findings

- Hemobilia after transjugular liver biopsy can present with acute pancreatitis and obstructive jaundice.
- ERCP was both diagnostic and therapeutic in this case, leading to full recovery.
- Clinicians should consider hemobilia in patients with unexplained jaundice or pancreatitis post-TJLB.

## Abstract

Liver biopsy is a critical diagnostic tool in the evaluation of certain hepatic and biliary disorders, particularly when non-invasive testing is inconclusive. It allows for definitive histopathologic assessment, guides prognostication, and informs therapeutic decision-making. Several techniques for liver biopsy are available, including percutaneous, transjugular, and surgical approaches. Among the available techniques, transjugular liver biopsy (TJLB) is considered to have a superior safety profile compared to other techniques. However, complications still occur, and hemobilia is one such rare but potentially serious event. While multiple cases of hemobilia following percutaneous liver biopsy have been reported, occurrences after TJLB are exceedingly uncommon. We present a case of hemobilia developing after a TJLB. The diagnosis can be challenging because the initial presentation is often nonspecific. In our case, the patient did not exhibit overt gastrointestinal bleeding but presented with acute pancreatitis and obstructive jaundice, which led to further evaluation and the eventual diagnosis of hemobilia. Endoscopic retrograde cholangiopancreatography (ERCP) was both diagnostic and therapeutic, resulting in complete clinical and biochemical recovery. This case highlights the importance of maintaining a high index of suspicion for hemobilia following TJLB, particularly in patients presenting with unexplained jaundice or pancreatitis even in the absence of overt gastrointestinal bleeding.