Resistant Hilar Stricture Following Transarterial Bleomycin-Lipiodol Embolization for a Large Hepatic Hemangioma

Symptomatic hepatic hemangiomas are commonly treated by transcatheter arterial embolization as an alternative to surgical resection. Bile duct complications are rare. An 80-year-old woman had a progressive refractory stricture postbleomycin transcatheter arterial chemoembolization. Magnetic resonance cholangiopancreatography showed that the hemangioma reduced in size, but there was a new 2 cm hilar stricture on cholangiopancreatography. Digital cholangioscopy and biopsy showed benign changes. Despite repeat dilations and stent treatments, she had persistent stricture and recurrent cholangitis. The stricture was not operable. The stricture was likely from angiosclerotic effects of bleomycin. The bile duct is prone to ischemic injury as it lacks dual blood supply.