Percutaneous cystic duct embolization with microvascular plug and LAVA liquid embolic system for persistent bile leak following cholecystectomy.

Bile duct injury from laparoscopic cholecystectomy is an uncommon complication. Percutaneous cystic duct embolization has been used to treat bile leaks from the cystic duct in patients who are not surgical candidates or who have failed endoscopic retrograde cholangiopancreatography (ERCP). A case of a 48-year-old man who underwent cholecystectomy complicated by bile leak and biloma in the gallbladder fossa requiring drain placement is presented. The patient initially underwent ERCP with sphincterotomy of the major duodenal papilla and common bile duct stent placement. However, due to a persistent bile leak, a percutaneous cystic duct embolization procedure was performed through the gallbladder fossa using a microvascular plug and the LAVA® Liquid Embolic System (LES) in a retrograde fashion. The output from the preexisting drain in the gallbladder fossa stopped within 3 days, and the drain was removed after follow-up abdominal computed tomography at 1 week, which confirmed resolution of the biloma. The LAVA LES has not been reported in the literature with respect to cystic duct embolization.