Hemorrhagic shock necessitating resuscitation and damage control surgery after needle biopsy: A report of two cases

Abstract

Percutaneous needle biopsy is minimally invasive and widely performed. Bleeding is an important complication of needle biopsy. Because the wound created by the needle is small, the recognition of bleeding in the body may be delayed, and this delay can lead to hemorrhagic shock and death. We report two cases of hemorrhagic shock in which the trauma triad of death developed after needle biopsy and the patients required resuscitation and damage control surgery. Needle biopsy is less invasive but cannot stop bleeding, and so surgery should be considered to ensure hemostasis in a compromised patient.

Keywords: Damage control surgery; Deadly triad; Hemorrhagic shock; Needle biopsy.

Fig. 1

Confirmed bleeding from the lateral portion of the liver. The bleeding site (white arrow) was closed with sutures and an electric device, but the closure was difficult because the patient had coagulopathy.

Fig. 2

Right thoracotomy was performed because of posterior pleural bleeding. A large amount of blood and many clots were observed.

Fig. 3

Confirmed bleeding from the posterior pleura. The bleeding site was closed with sutures, and the bleeding was stopped. In this photograph, the tip of the suction is at the bleeding point.

Fig. 4

Abdominal computed tomographic image, which was ordered from another hospital at a later date, showed a mass in the lateral portion of the liver. Cancer was diagnosed; the primary neoplasm was unknown. In the other hospital, percutaneous needle biopsy had been performed to determine the primary cancer.