Haemobilia mimicking acute cholecystitis following percutaneous renal biopsy.

in the right upper quadrant (RUQ) with voluntary of; haemobilia; gallbladder; haemorrhage guarding. Rectal exam revealed guaiac positive stool. Laboratory values were significant for white blood cell count of 12 000/mm3, alanine aminotransferase of 158 Introduction U/l, aspartate aminotransferase of 310 U/l, and total and direct bilirubins of 1.6 and 0.9 mg/dl, respectively. Her haematocrit was 39.2%. Ultrasound revealed a The incidence of iatrogenic haemobilia has increased distended gallbladder with a large amount of hetero-in parallel with the increasing utilization of percutan-geneous material consistent with blood or sludge but eous procedures involving the liver [1]. In the majority no stones. No gallbladder wall thickening or perichole-of instances, haemobilia is of little clinical significance. cystic fluid was noted. Biliary ducts were of normal In this report, we describe a patient who presented calibre. Computed tomography scan confirmed the with an intracholecystic bleed mimicking acute cholecy-presence of a distended gallbladder with heterogeneous, stitis 4 days following a percutaneous renal biopsy. high-attenuation material consistent with blood or sludge. No perihepatic or perirenal haematoma was noted (Figure 1). Case The patient's hospital course was notable for persistent localized RUQ pain and tenderness and a continued A 33-year-old female with a 10-year history of an decrease in her haematocrit to 32.6%. Nuclear imaging uncharacterized rheumatologic disorder underwent a scan demonstrated delayed gallbladder filling, but no percutaneous biopsy of her right kidney because of evidence of acute calculous cholecystitis. The final persistent haematuria, proteinuria, and mild renal report from the biopsy, in addition to the kidney insufficiency. Both kidneys were identified by ultra-findings, revealed the presence of a small fragment of sonography with the patient in the prone position. A 15-gauge spring-loaded biopsy needle was inserted perpendicular to the skin at a site marked by ultra-sound guidance. Two passes were performed, each yielding tissue, which demonstrated glomeruli under low power microscopy. No perinephric haematoma was evident on post-procedural ultrasound. The patient's post-biopsy haematocrit was 40% compared with her pre-biopsy haematocrit of 43.9%, and the patient was discharged the following morning. The patient presented to the emergency department 4 days later with complaints of right flank and upper abdominal pain, which had worsened acutely over the previous 12 h. Her medications upon admission included prednisone at 40 mg a day. The patient had been on chronic steroids for several years for her rheumatologic disorder. She denied any fever, chills, Fig. 1. Computed tomography of the upper abdomen …