Non-target lung embolization during portal vein embolization due to an unrecognized portosystemic venous fistula: A case report

BACKGROUND: Portal vein embolization (PVE) is an effective and relatively safe procedure performed prior to major hepatic resection to enhance future liver remnant. Non-target embolization during PVE is rare, and if it occurs, it usually affects the future liver remnant. Intrahepatic portosystemic venous fistulas are extremely rare in non-cirrhotic livers. We report a case of non-targeted lung embolization during PVE due to an unrecognized intrahepatic portosystemic fistula. CASE SUMMARY: A 60-year-old male presented with metastatic colon cancer of the liver. The patient underwent preoperative right PVE. During the embolization procedure, a small amount of glue and lipiodol emulsion was embolized to the heart and lungs through an unrecognized intrahepatic portosystemic fistula. The patient remained clinically stable and underwent the planned hepatic resection after 4 wk, with an uneventful postoperative course. CONCLUSION: Conventional portograms and careful evaluation prior to PVE are advisable to avoid such complications.