Liver Biopsy in Children in Dhaka Shishu Hospital A Study of 30 Cases

Abstract

Background: Liver biopsy is an established procedure to diagnose disease, to assess
prognosis and to follow up of liver diseases. Although liver biopsy is a confirmatory diagnostic
procedure of majority of the hepatological disorders, it carries the risk of complications.
Though major complications rarely occur, minor complications are common. To minimize
complications, several biopsy techniques have been developed. The present study was
intended to correlate the clinical diagnoses with histological diagnoses and to observe
the complications encountered by the children with percutaneous liver biopsy procedure.
Patients and Methods: A total of 30 paediatric patients of suspected liver diseases,
based on predefined eligibility criteria, were subjected to biopsy for confirmation of
diagnosis. An ultrasound of liver was routinely performed before the procedure to mark
the site for percutaneous biopsy. The field was prepared with alcohol-based solution
(povidone-iodine) and sterile drapes were placed over the patient. Local anaesthetic
was administered with 2% lidocain solution 20mg/ml (preferably levobupivacaine 2.5mg/
ml) in both superficial and deep planes. A blind liver biopsy was done at the point of
maximum dullness by percussion over the right trunk. We used cutting needle. The
diameter of the needle used in our study was 14-gauge (1.4 mm) which allowed adequate
collection of tissue for diagnosis. The biopsy material was taken in a very small amount
of sterile normal saline and was immediately sent to the laboratory for evaluation.
Results: Half (50%) of the patients was more than 5 years of age with median age
being 5.0±3.9 years. Majority (80%) was male. Ninety percent of the patients belonged
to poor socioeconomic class. Clinically the cases were diagnosed as having chronic
hepatitis (23.3%) followed by CLD (16.7%), isolated hepatomegaly (16.7%), liver
cirrhosis (13.3%) and storage disease (13.3%). Hepatosplenomegaly and congenital
hepatic fibrosis, each was 6.7%. Histological diagnoses of biopsy material obtained
from the liver confirmed that one-sixth (16.7%) of the cases had liver cirrhosis. Storage
disease and glycogen storage disease each comprised 13.3% of the cases and
congenital biliary atresia 10%. Very few cases had moderate fatty changes with
cholestasis, congenital hepatic fibrosis, chronic inflammatory cells, chronic viral
hepatitis and secondary biliary cirrhosis. Nearly half (46.7%) patients had mild pain
and discomfort at the site of biopsy, most of which spontaneously went away. However,
some 3 (10%) patients developed major complications needing management.
Conclusion: Liver biopsy is a well established procedure in the diagnosis and follow up
of liver diseases. But it is not without risk of complications. So, before deciding for a
liver biopsy, the indications and risks must be assessed cautiously for each patient.

Key words: Percutaneous liver biopsy; clinical diagnoses; histological diagnoses; complications.

DOI: 10.3329/bjch.v34i1.5694

Bangladesh Journal of Child Health 2010; Vol.34(1): 1-6