Delayed bilhemia complicating percutaneous transhepatic biliary drainage: Successful treatment with primary coil embolization

Bilhemia is very rare and serious complication of percutaneous transhepatic biliary drainage (PBD). Bile leakage occurs into the bloodstream through a fistula between the biliary tree and the hepatic venous system. We report a case of a 45-year-old woman with bilhemia complicated by PBD. She was successfully treated with primary coil embolization of biliovenous fistula tract. In the follow-up, bilirubin values dramatically regressed and returned to its normal limits. Rapid increase in total and direct bilirubin values after PBD without biliary tree dilatation almost always suggest biliovenous fistula. It is more likely that biliovenous fistulas will develop in catheters that are removed before the time of the tract maturation. Symptomatic bilhemia should be treated as soon as possible to prevent major complications like bile pulmonary embolism and biliary sepsis.