Abstract
We report the case of an elderly male, who was a known case of chronic liver parenchymal
disease. He presented with a history of melena for 2 weeks and upper-GI endoscopy
revealed fundal varices. He was planned for BRTO. Along with BRTO, a percutaneous
trans-hepatic puncture of a branch of the right portal vein was also performed for
proper embolization of the varices. The trans-hepatic puncture-tract was embolized
after the procedure. However, after 24 hours of the procedure, the patient developed
hypotension and abdominal distension due to hemorrhage from the portal puncture site.
Portal-venography was performed via the trans-jugular-trans-hepatic route to confirm
the source of hemorrhage and embolization of the culprit portal venous branch was
performed via the same route. The patient was stable after the procedure.
Various interventional procedures via the trans-jugular route have been routinely
described in the literature, including trans-jugular liver biopsies, placement of
TIPSS shunts and endovascular interventions for haemodialysis. However, the literature
on trans-jugular embolization of portal vein is scarce. This case describes the unexpected
clinical situation, in the form of bleeding from the portal puncture site, despite
embolization of the trans-hepatic tract after BRTO. Finally, a creative solution was
thought of and trans-jugular embolization of the portal vein was performed, which
succeeded in terminating the ongoing bleeding from the portal vein.
Keywords
BRTO - portal vein embolization
