Delayed intrabiliary migration of embolization material after hepatic arterial embolization: a case report

Transcatheter arterial embolization (TAE) using metallic coils is a widely accepted treatment for arterial bleeding in hepatobiliary surgery. Although generally safe, delayed migration of embolization materials into the biliary system is a rare but clinically significant complication that may lead to recurrent biliary symptoms. Early diagnosis can be challenging because of anatomical overlap and imaging limitations.

We report a 73-year-old man with recurrent choledocholithiasis and cholangitis following right hepatic artery embolization with metallic coils. After laparoscopic cholecystectomy and common bile duct exploration complicated by postoperative hemorrhage, TAE was performed successfully. Two years later, the patient developed recurrent biliary symptoms and underwent multiple endoscopic retrograde cholangiopancreatography (ERCP) procedures. Post-procedural T-tube cholangiography and subsequent ERCP demonstrated bile duct dilatation and persistent metallic shadows in the hepatic hilum; however, definitive intrabiliary localization of the embolization material could not be established because of anatomical overlap and the absence of a clear filling defect. During a later ERCP for recurrent cholangitis, a metallic wire-like structure was partially extracted under direct endoscopic visualization, confirming intrabiliary involvement of embolization material. Further removal was withheld because of resistance during traction and concern for vascular injury.

This case illustrates the gradual and diagnostically ambiguous nature of intrabiliary migration of embolization materials following hepatic arterial embolization. Repeated evaluation over time and cautious endoscopic decision-making may be necessary when recurrent biliary symptoms occur after embolization.