Bilhemia in a Liver Transplanted Child: A Rare but Severe Complication of Percutaneous Transhepatic Cholangiography

BACKGROUND: Percutaneous transhepatic cholangiography (PTC) is commonly performed after liver transplantation in children for the management of bilioenteric anastomosis strictures. In this setting in which pressure in bile ducts is higher than in the venous system, accidental traumatic bilio-venous fistula may lead to bilhemia, that is, bile leakage into the bloodstream through the fistula, but this complication has never been reported in children after PTC. METHODS AND RESULTS: We report the case of a young child who experienced severe bilhemia following PTC after liver transplantation. The blood levels of all four major bile components (i.e., cholesterol, bile acids, bilirubin, and phospholipids) were highly elevated, suggesting the presence of bilhemia. Conventional imaging techniques did not reveal the abnormal communication, which was confirmed through direct bile duct opacification. Placement of multiple stents within the hepatic vein, along with dilatation of a bilioenteric anastomosis stricture, enabled fistula occlusion and led to complete recovery. CONCLUSION: This case demonstrates that bilhemia can occur in children after PTC and emphasizes the diagnosis and management modalities of this rare complication.