Biliary venous fistula: an unusual complication of fine-needle aspiration biopsy of the liver.

© SCVIR, 1995 THE incidence of complications following fine-needle (external diameter < 1 mm; 20-23-gauge) aspiration biopsies (FNABs) in the abdomen is low, with a reported rate of 0.55%. Major complications including bile peritonitis, bacterial peritonitis, intrahepatic hematoma, tumor seeding, and death have been reported to occur in 0.003%-0.1% of cases (1,2). Blood may enter the biliary system in association with hepatic trauma, cholelithiasis, surgery, or percutaneous interventional procedures resulting in hemobilia. Bile entering the vascular system, or hyperbilirubinemia, is a rare clinical situation that has been reported in association with biliary obstruction from common bile duct stones and a normal blood vessel (3-11). However, we describe a patient with a nondilated biliary system and cavernous transformation of the portal vein (CTPV) who developed an acute biliary-venous fistula associated with severe hyperbilirubinemia or bilemia following percutaneous FNAB of the liver.