A 69-year-old Chinese male complained of yellow discoloration of the skin and urine with abdominal distension. The patient was admitted to the emergency department of our hospital in the afternoon of June 11, 2020 complaining of left lower back pain and hematuria caused by a fall 6 h previously. His blood pressure was 81/46 mmHg at admission, and laboratory tests revealed a hemoglobin level of 80 g/L, blood urea nitrogen of 7.9 mmol/L, creatinine of 105 μmol/L, and pH 7.30. Ultrasonography (US) and contrast-enhanced CT (60 mL, 270 mg of iodine/mL; Yangtze River Pharmaceutical Group, Taizhou, China) revealed bilateral polycystic kidney with rupture of the left kidney, a huge hematoma, and multiple liver cysts. The gallbladder and pancreas were normal. Emergency renal artery embolization (RAE, 150 mL iodixanol) was performed, after which his blood pressure promptly returned to normal and hematuria decreased. On the second day after RAE (d1-post-RAE), the patient complained of abdominal distension with absence of the passage of both flatus and stool. Paralytic intestinal obstruction was diagnosed together with absence of bowel sounds. He was treated with fasting, gastrointestinal decompression, fluid replacement, and octreotide (100 mg, once daily; Novartis Pharma Schweiz AG, Risch-Rotkreuz, Switzerland). On d5-post-RAE, the patient resumed passage of both flatus and stool, and the above treatments were discontinued. He had a history of polycystic kidney disease for 40 years, but had no other illnesses. He denied a history of similar diseases in close relatives. Physical examination revealed that the skin and sclera were slightly jaundiced, and a mass 16 cm × 12 cm in size on the left flank was observed, which was soft and tender with percussion pain in the left renal region. There were no abnormal liver and gallbladder findings. On d6-post-RAE, the patient’s sclera and skin were slightly yellow, and was worse the following day. Laboratory tests showed that the levels of bilirubin, alkaline phosphatase (AKP) and gamma-glutamyl transpeptidase (γ-GT) were significantly increased, but transaminases were normal. Urinalysis showed that urinary bilirubin was positive and urobilinogen was negative. On d3-post-RAE, non-contrast CT showed high density in the gallbladder and colon, which was considered to be due to VCME, while in the upper pole of the left kidney CM had spilled out of the renal artery. On d7-post-RAE, repeat US revealed a large amount of sludge in the gallbladder, but no dilation of intrahepatic and extrahepatic bile ducts.