Immediate Hemobilia Following Percutaneous Liver Biopsy: A Case Report of an Acute Symptomatic Presentation

Hemobilia is a rare but potentially serious complication of percutaneous liver biopsy, typically presenting hours to days after the procedure.We report a case of acute symptomatic hemobilia occurring approximately 10 minutes after completion of an ultrasound-guided biopsy of a LI-RADS 4 (Liver Imaging Reporting and Data System) hepatic lesion in a 55-year-old man.The patient developed sudden right upper quadrant pain followed by hematemesis.Immediate bedside ultrasound demonstrated newly developed echogenic material occupying approximately half of the gallbladder lumen, whereas the pre-procedural examination had shown an anechoic gallbladder.Emergency multiphasic computed tomography (CT) revealed hyperattenuating material within the gallbladder, consistent with acute blood products, without evidence of active contrast extravasation or an identifiable vascular lesion.Although no vascular-biliary communication was demonstrated, the clinical presentation and sequential imaging findings strongly supported the diagnosis of acute post-biopsy hemobilia.Given the patient's hemodynamic stability and absence of evidence of ongoing bleeding, conservative management was undertaken, resulting in an uneventful recovery.This case highlights the importance of considering hemobilia during the immediate post-biopsy period and illustrates the complementary roles of ultrasound and multiphasic CT in its diagnostic evaluation.