Peritoneal Dissemination after Preoperative Percutaneous Transhepatic Portal Vein Embolization in Hilar...

Preoperative percutaneous transhepatic portal vein embolization is used to induce future liver remnant hypertrophy before major hepatectomy in perihilar cholangiocarcinoma. We report a patient who developed peritoneal nodules along the suspected transhepatic puncture route after right-sided percutaneous transhepatic portal vein embolization. Histopathology showed adenocarcinoma consistent with the primary tumor. The spatial distribution and timing were considered more suggestive of tract-related seeding from bile leakage rather than hematogenous spread. This rare but serious complication warrants preventive strategies, including careful route planning, strict avoidance of bile contamination, minimization of puncture attempts, and secure tract closure.