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 pancreatic 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 disclosed 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 communication made by trauma between the biliary tree and the hepatic vein.