# A Rare Case of Obstructive Jaundice Secondary to Hemobilia Post Endoscopic Ultrasound Guided Liver Biopsy

## TL;DR

A rare case of jaundice caused by hemobilia after a liver biopsy highlights the need to consider this complication in similar procedures.

## Contribution

This paper reports the second documented case of hemobilia-induced obstructive jaundice following endoscopic ultrasound-guided liver biopsy.

## Key findings

- Hemobilia can cause obstructive jaundice after endoscopic ultrasound-guided liver biopsy.
- ERCP revealed biliary blockage, which was resolved with sphincterotomy and stent placement.
- The case suggests sphincter of Oddi dysfunction and papillary stenosis may contribute to elevated liver enzymes.

## Abstract

Hemobilia is an uncommon complication of endoscopic liver biopsy (LB), rarely resulting in clinically significant biliary obstruction. We describe the second reported case of hemobilia‐induced obstructive jaundice secondary to endoscopic ultrasound‐guided LB (EUS‐LB). A 57‐year‐old man presented with jaundice and abdominal pain 2 days after undergoing EUS‐LB for persistently high liver enzymes, which revealed nonspecific biliary dilation. Endoscopic retrograde cholangiopancreatography (ERCP) revealed hemobilia‐induced biliary blockage, relieved with sphincterotomy and stent placement, suggestive of sphincter of Oddi dysfunction and papillary stenosis as the initial cause of liver enzyme elevation. This case emphasizes the significance of considering hemobilia as a differential for obstructive jaundice post EUS‐LB, which is generally regarded as a safe and minimally invasive procedure.

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