Percutaneous transhepatic ethanol ablation for postoperative bile leakage after a hepatectomy

A 68-year-old male underwent a partial hepatectomy for hepatocellular carcinoma located in S5 close to the confluence of the anterior and posterior Glisson's sheath. Thereafter, bile leakage developed from the drain on postoperative day (POD) 2. Endoscopic nasobiliary drainage of the biliary tree and percutaneous drainage of the biloma proved ineffective, and the bile leakage continued at a constant volume of 40 mL per day. A fistulogram on POD 62 demonstrated an enhancement of the isolated bile duct. Ethanol injection into the isolated bile duct was attempted to ablate biliary epithelium but this was unsuccessful because it was impossible to insert the tube into the isolated bile duct. Ethanol was injected into the liver parenchyma surrounding the isolated bile duct via the percutaneous transhepatic approach under sonographic guidance on POD 78 in order to eliminate the production of bile juice by destroying both the biliary epithelium and liver parenchyma. The bile leakage decreased one day following the ethanol injection, although the patient experienced a prolonged fever for a week, and he was discharged on POD 100. This is the first report of ethanol injection into the liver parenchyma by a percutaneous transhepatic approach, instead of into the bile duct, to treat intractable bile leakage.