Arterioportal fistula with hepatic artery pseudoaneurysm: A rare complication of percutaneous transhepatic biliary drainage

We describe a rare complication of percutaneous transhepatic biliary drainage in a 51-year-old female with recurrent hilar cholangiocarcinoma. The patient presented with blood-mixed pericatheter leak of bile, 1 month after placement of a 10F ring biliary internal-external drainage catheter through the left-sided biliary radical. Color Doppler and triphasic computed tomography angiography revealed a pseudoaneurysm arising from segment 3 branch of the left hepatic artery and an arterioportal fistula immediately distal to the pseudoaneurysm. Endovascular coil embolization of the hepatic artery proximal to the pseudoaneurysm was done which resulted in occlusion of the pseudoaneurysm and fistula as well as clinical improvement in the symptoms.