Bile duct embolization is a highly specialized procedure used at Stanford Medicine Children's Health for select, challenging pediatric cases of persistent bile leaks or fistulas. These complex situations can arise as a complication of prior surgeries, such as liver transplantation or major biliary reconstruction, as well as from severe trauma.
This procedure is typically reserved for cases where more common, first-line interventions, such as biliary drainage or stenting, have failed to resolve the leak. The use of this technique reflects the high level of specialized care available at Stanford, where a multidisciplinary team—including pediatric interventional radiologists, transplant surgeons, and hepatologists—collaborates to manage the most complex and difficult patient cases. The goal is to avoid more extensive surgery, reduce patient recovery time, and prevent serious complications like infection (cholangitis) and liver damage from uncontrolled bile leakage.
Example: 16F with intermittent post-prandial abdominal pain and vomiting
MRCP shows her biloma has definitely increased in size, and suspect the leak may even be coming from the left side because there are some bilomas there |
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 | - IR drain exchange/upsize with DHo, removed 600cc of bile
- Place a 12Fr x 45 cm MPD
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| - ERCP with stent exchange (8mm x 6 cm) and intraop cholangio actually shows the bile leak.
- The stent, and notably here, after stent placement, there is no bile leak.
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GI/GS Procedure |
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2 weeks later some of the clips actually migrated |  |
| - Kumpe catheter placed → gentle puff → minimal visualization.
- Glidewire advanced → false tracts formed → backup called.
- Scope advanced into CBD; wire difficult to pass.
- Balloon cholangiogram performed → tiny leak noted (0:36:48).
- Both IR and GI probing; GI wire advanced first (0:42).
- Balloon positioned near leak → repeat cholangiogram → culprit identified.
- Variant anatomy: cholecystohepatic duct (duct of Luschka) draining segments 5/8 into gallbladder.
- Coil length into cystic duct stump measured.
- Glidewire successfully advanced → case proceeded.
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| Placed 8 Fr × 11 cm Avanti sheath with Nitrex safety wire → sclerosed isolated cholecystohepatic duct using 2.5 cc 4:1 histocryl:lipiodol with balloon backstop → subsequent coiling with Penumbra coils (20 mm POD 3, 45 mm packing, 2 × 5 mm packing). |
| MR without significant persistent bile leak |
