Hemobilia and pancreatitis after liver transplant biopsy

A 51-year-old male presented after liver transplant biopsy with severe abdominal pain. This occurred 2 years after a combined liver-kidney transplant for end-stage liver disease from alcoholic cirrhosis and end-stage renal disease from chronic glomerulonephritis. His posttransplantation course was unremarkable. His other medical history included hypertension. His was not on any anticoagulation medication, and his maintenance immunosuppression included tacrolimus and mycophenolate mofetil. His liver and kidney function prior to biopsy was normal (Table 1). At our institution, patients routinely undergo surveillance liver biopsy on a yearly basis, and this was the only indication for biopsy. The biopsy was performed in the right lobe by interventional radiology under ultrasonographic guidance with an 18-gauge BioPrince biopsy gun. A Doppler ultrasound prior to biopsy was unremarkable. One hour after the biopsy, the patient developed severe abdominal pain. A noncontrast computed tomography (CT) scan of the abdomen looking for subcapsular hematoma revealed an intraluminal density in the second and third portions of the duodenum. Immediately after the CT scan, the patient passed a large bloody stool. Upon further review of the CT scan, the intraluminal densities in the duodenum were thought to be blood