PMC7711210_01
Computed tomography prior to percutaneous transhepatic portal embolization (PTPE) showing biloma with inserted percutaneous catheter drainage (dashed arrow) in the right posterior section of the liver and right posterior portal vein (arrow), which is the target of PTPE.
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Based on this, we again performed PCD for biloma (Fig. 1).
Percutaneous transhepatic portal vein embolization (PTPE) procedure. (a) Portogrpahy performed using a 5Fr catheter in the superior mesenteric vein inserted via the peripheral right anterior portal vein showing the overall anatomy of the intrahepatic portal system, including the right posterior portal vein (arrow), which is the target of PTPE. (b) Selective right posterior portography was performed using a 5Fr reverse catheter (Yashiro catheter; Terumo, Tokyo, Japan). (c) After portal vein embolization with a gelatin sponge and NBCA and Lipiodol mixture, complete portography showing complete occlusion of the right posterior portal vein.
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In addition, we performed portography for overall portal anatomy, which revealed centripetal portal flow (Fig. 2a) and used a 5Fr reverse catheter (Yashiro catheter; Terumo, Tokyo, Japan) to cannulate the right posterior portal vein (Fig. 2b). Completion portography revealed complete occlusion of the right posterior portal vein (Fig. 2c).
Follow-up computed tomography (CT) after percutaneous transhepatic portal vein embolization (PTPE) (a) Follow-up CT 10 days after PTPE showing complete occlusion of the right posterior portal vein with n-butyle cyanoacrylate and Lipiodol mixture and nearly resolved biloma with the insertion of percutaneous catheter drainage. (b) Follow-up CT 1 year after the PTPE showing atrophied right posterior section of the liver without recurrence of the biloma.
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Ten days after PTPE, PCD drainage was nearly negative and follow-up CT revealed complete embolization of the right posterior portal vein with resolution of the previous biloma (Fig. 3a). Last follow-up CT that was performed after 1 year revealed atrophied right posterior section of the liver and no recurrence of the biloma (Fig. 3b).