Portal vein embolization for an intractable bile leakage after hepatectomy

Bile leakages due to interruption of the intrahepatic bile duct after hepatectomy are often intractable. We herein report a case where portal vein embolization (PVE) decreased the bile production from the embolized part of the liver, which lead to healing of this type of bile leakage. A 77-year old man who had undergone an anterior segmentectomy of the liver for hepatocellular carcinoma 3 years prior was admitted to our hospital for an abscess in the right subphrenic space, and underwent percutaneous drainage. Fluoroscopy using a contrast medium from the drainage tube revealed that the root of the posterior branch of the bile duct was completely interrupted. The hilar side of the interrupted bile duct was closed, and all the bile from the posterior segment continued to be discharged at a rate of 100-150 ml/day for 2 months. The posterior branch of the portal vein was then embolized with fibrin glue by percutaneous transhepatic approach. After the PVE, the volume of discharge gradually decreased, and the drainage tube was removed 2 weeks after the PVE. Three months later, the patient was afebrile and doing well. PVE might be a useful method for treating interrupted type postoperative bile leakages.