Published online May 26, 2023. doi: 10.12998/wjcc.v11.i15.3625
Peer-review started: January 14, 2023
First decision: January 30, 2023
Revised: February 14, 2023
Accepted: April 13, 2023
Article in press: April 13, 2023
Published online: May 26, 2023
Processing time: 131 Days and 14.8 Hours
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.
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.
Conventional portograms and careful evaluation prior to PVE are advisable to avoid such complications.
Core Tip: Portal vein embolization (PVE) is relatively safe procedure done prior to major hepatic resection to enhance the future remnant liver. Intrahepatic portosystemic venous fistula is very rare in non-cirrhotic liver. Non-target embolization is a rare complication of such a procedure. This is the first case report of non-target lung embolization during PVE through a portosystemic venous fistula. Failure of recognition of this rare vascular abnormality led to this rare complication. In our case, we emphasize on careful evaluation of conventional portogram prior to PVE to avoid such complication.