Direct percutaneous access to an omental vein for embolization of Roux-en-Y limb varices in a child

An 11-year-old boy with a history of hepatoblastoma treated with chemotherapy, radiation therapy, and liver transplantation presented with bleeding from Roux-en-Y limb varices. The transhepatic approach for portal intervention posed a risk of liver graft injury. An omental vein that was dilated as a collateral vein due to portal hypertension was found and compressible under ultrasound. The omental vein was percutaneously punctured, and the varices were embolized through a jejunal vein. No complication occurred. Direct percutaneous access to the portal venous system is a useful technique for portal embolization.