Fatal Bile Pulmonary Embolism following Percutaneous Transhepatic Cholangiodrainage: Case Report and Literature Review

Bile pulmonary emboli were present at autopsy in a seventy-year-old woman who had undergone percutaneous transhepatic cholangiodrainage for pancre atic carcinoma obstructing the common bile duct. The patient also developed hemobilia following the drainage. In spite of emergency surgery, she died on the third day after the operation. Microscopic findings of the lungs at autopsy dis closed numerous bile emboli in the smaller arteries, arterioles, and capillaries. Review of the literature showed 13 cases of bile pulmonary embolism, 10 of which had an obvious history of marked jaundice and trauma to the liver, like the present case. Bile enters the systemic circulation through a fistulous com munication made by trauma between the biliary tree and the hepatic vein.