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Permanent hilar biliary obstruction after transjugular intrahepatic portosystemic shunt. Asian J Surg 2022; 46:1600-1601. [PMID: 36210303 DOI: 10.1016/j.asjsur.2022.09.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/19/2022] [Indexed: 11/22/2022] Open
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2
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Macinga P, Gogova D, Raupach J, Jarosova J, Janousek L, Honsova E, Taimr P, Spicak J, Novotny J, Peregrin J, Hucl T. Biliary obstruction following transjugular intrahepatic portosystemic shunt placement in a patient after liver transplantation: A case report. World J Hepatol 2022; 14:1038-1046. [PMID: 35721285 PMCID: PMC9157702 DOI: 10.4254/wjh.v14.i5.1038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/28/2022] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is a method used to decrease portal hypertension. Biliary stricture is the rarest of the complications associated with this procedure with only 12 cases previously reported in the literature. None of these cases have documented the resolution of biliary stenosis induced by a stent graft. The only curative solutions reported are liver transplantation or bypassing the stenosis with an artificial biliary tract using advanced endoscopic techniques.
CASE SUMMARY This is the first reported case of biliary obstruction secondary to TIPS placement in a transplanted liver. In our patient, a portosystemic shunt was created to treat severe veno-occlusive liver graft disease manifesting itself primarily by fluid retention. A cholestatic liver lesion and cholangitis with abscesses developed due to a stent graft-induced stricture in the dorsal segment of the right hepatic duct and the stricture diminished following percutaneous drainage. Endoscopic drainage was performed after unsuccessful removal of the percutaneous catheter resulting in a bilio-cutaneous fistula. Although the liver graft now functions well, the stricture remains refractory even after 44 mo of treatment.
CONCLUSION Biliary strictures caused by TIPS in both transplanted and native livers seem refractory to endoscopic treatment.
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Affiliation(s)
- Peter Macinga
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
| | - Darina Gogova
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
| | - Jan Raupach
- Department of Radiology, University Hospital, Hradec Kralove 50005, Czech Republic
| | - Jana Jarosova
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
| | - Libor Janousek
- Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
| | - Eva Honsova
- Department of Pathology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
| | - Pavel Taimr
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
| | - Julius Spicak
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
| | - Jiri Novotny
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
| | - Jan Peregrin
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
| | - Tomas Hucl
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
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Biliary obstruction following transjugular intrahepatic portosystemic shunt placement in a patient after liver transplantation: A case report. World J Hepatol 2022. [DOI: 10.4254/wjh.v14.i5.1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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4
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Dulcetta L, Marra P, Carbone FS, Bonaffini PA, Sallemi C, Sansotta N, Colledan M, D'Antiga L, Sironi S. Biliary complications in pediatric liver transplantation: findings of percutaneous transhepatic cholangiography in a large single-center cohort. Pediatr Radiol 2022; 52:1061-1074. [PMID: 35107594 DOI: 10.1007/s00247-021-05278-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/09/2021] [Accepted: 12/27/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although biliary complications after orthotopic liver transplantation represent a common source of morbidity and mortality, decreasing graft survival, consensus is lacking on their management in the pediatric population. OBJECTIVE The aim of this study was to present the prevalence of such biliary complications and their interventional radiologic management with representative images. MATERIALS AND METHODS This retrospective study reports our experience with percutaneous transhepatic cholangiography in the management of biliary complications after orthotopic liver transplantation in pediatric patients. This study enrolled all pediatric patients (<18 years old) who underwent percutaneous transhepatic cholangiography for the management of biliary complications after orthotopic liver transplantation at a tertiary care center between January 2010 and December 2020. Diagnosis of biliary complications and indication to perform percutaneous transhepatic cholangiography were based on clinical, laboratory or radiologic data. RESULTS Among the 301 orthotopic liver transplantations, 78 (26%) developed biliary complications that were managed by interventional radiology: these included 52 (17.3%) biliary strictures, 19 (6.3%) bile leaks, 5 (1.7%) biliary stones, 1 (0.3%) iatrogenic biliary obstruction and 1 (0.3%) vanishing syndrome. The median time interval between orthotopic liver transplantation and the diagnosis of biliary complications was 6.0 years (interquartile range [IQR] 8.2 years). Percutaneous transhepatic cholangiography and biliary duct catheterization were successful in all cases, with low rates of complications that were variable among subgroups. CONCLUSION A wide spectrum of biliary complications can occur after pediatric orthotopic liver transplantation. In this large single-center experience, we highlight the value of percutaneous transhepatic cholangiography in their diagnosis and management. Percutaneous treatments in pediatric patients are safe and effective, providing resolution or serving as a bridge to surgery, including re-transplantation.
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Affiliation(s)
- Ludovico Dulcetta
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy. .,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Francesco Saverio Carbone
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Claudio Sallemi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Naire Sansotta
- Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Michele Colledan
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Lorenzo D'Antiga
- Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Mehmood F, Khalid A, Frager S. Perihepatic Biloma in a Non-cirrhotic Patient After Transjugular Intrahepatic Portosystemic Shunt (TIPS). Cureus 2022; 14:e23399. [PMID: 35481310 PMCID: PMC9033531 DOI: 10.7759/cureus.23399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Biloma is an intrahepatic or extrahepatic collection of bile within the abdominal cavity. It can occur spontaneously, or as a result of trauma to the biliary tree. The clinical presentation can be variable and non-specific. Early diagnosis is crucial given the high mortality rate. Diagnostic modalities include abdominal ultrasound, hepatobiliary scintigraphy, computerized tomography (CT), and magnetic resonance imaging (MRI). Treatment options include interventional radiology (IR)-guided drainage, endoscopic drainage, or surgical drainage with a bile leak repair. We report a case of a middle-aged non-cirrhotic patient who presented with abdominal pain and was noted to have extensive portal vein thrombosis. She underwent transjugular intrahepatic portosystemic shunt (TIPS) with thrombectomy and the hospital course was complicated by elevated liver enzymes and found to have intrahepatic biloma requiring IR-guided drainage.
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Biliary Obstruction After Transjugular Intrahepatic Portosystemic Shunt Placement. ACG Case Rep J 2021; 8:e00618. [PMID: 34169113 PMCID: PMC8219257 DOI: 10.14309/crj.0000000000000618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 03/10/2021] [Indexed: 11/24/2022] Open
Abstract
A 19-year-old man with noncirrhotic portal hypertension status post transjugular intrahepatic portosystemic shunt, gastric esophageal varices status post coil embolization, and thrombophilia because of Factor V Leiden heterozygosity presented with jaundice and elevated liver enzymes. His cholangiogram during endoscopic retrograde cholangiopancreatography demonstrated biliary tract obstruction at the bifurcation of the right and left hepatic ducts. With the aid of digital single-operator cholangioscopy, the patient was found to have a perforation of the common hepatic duct from the shunt. This case presents a novel use for digital single-operator cholangioscopy in identifying this rare complication and appropriately differentiating biliary compression vs perforation from transjugular intrahepatic portosystemic shunt.
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Zhang L, Wei B, Wu H, Hu B. Intractable biliary obstruction after TIPS creation treated by magnet-assisted endoscopic biliary-duodenal anastomosis. Surg Endosc 2021; 35:467-470. [PMID: 32880750 DOI: 10.1007/s00464-020-07963-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Though biliary obstruction is a common clinical situation, it is rarely caused by transjugular intrahepatic portosystemic shunt (TIPS) placement. When TIPS-induced intractable biliary obstruction happens, liver transplantation seems to be the only resort to cure this condition. METHODS Herein, we describe a patient who suffered from intractable biliary obstruction following TIPS placement. RESULTS The patient was finally cured by magnet-assisted endoscopic biliary-duodenal anastomosis, without further requirement of liver transplantation. After more than 6 months of follow-up, this patient recovered well, and recurrence of biliary obstruction was not observed. CONCLUSION We showed that magnet-assisted endoscopic biliary-duodenal anastomosis is a safe method, which is easy to perform and worthy of popularizing.
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Affiliation(s)
- Linhao Zhang
- Department of Gastroenterology, West China Hospital, Sichuan University, Guo Xue Lane 37#, Chengdu, 610041, Sichuan, People's Republic of China
- Laboratory of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Guo Xue Lane 37#, Chengdu, 610041, Sichuan, People's Republic of China
| | - Bo Wei
- Department of Gastroenterology, West China Hospital, Sichuan University, Guo Xue Lane 37#, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hao Wu
- Department of Gastroenterology, West China Hospital, Sichuan University, Guo Xue Lane 37#, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Guo Xue Lane 37#, Chengdu, 610041, Sichuan, People's Republic of China.
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Bucher JN, Hollenbach M, Strocka S, Gaebelein G, Moche M, Kaiser T, Bartels M, Hoffmeister A. Segmental intrahepatic cholestasis as a technical complication of the transjugular intrahepatic porto-systemic shunt. World J Gastroenterol 2019; 25:6430-6439. [PMID: 31798279 PMCID: PMC6881513 DOI: 10.3748/wjg.v25.i43.6430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/25/2019] [Accepted: 11/07/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Segmental intrahepatic cholestasis caused by transjugular intrahepatic portosystemic shunt (TIPS) (SIC-T), is a rare complication of this technique and only referred by case reports. Thus, we conducted a systematic, retrospective analysis to provide evidence regarding prevalence and consequences of this TIPS-induced bile duct compression.
AIM To assess prevalence and outcome of SIC-T in a large TIPS-cohort.
METHODS In this retrospective cohort study, we screened the institutional databases for all consecutive patients that were treated by TIPS-placement or TIPS-revision between January 2005 and August 2013. We analyzed radiologic images for signs of biliary congestion. Cases that were indicative of SIC-T were reviewed by two independent radiologists and additional patient data was collected. Descriptive statistics of patient demographics, indications for TIPS and procedural details were registered. Logistic regression analysis was performed to identify predictors for the development of SIC-T.
RESULTS We analyzed 135 cirrhotic patients who underwent TIPS (mean age 55 years, 79% male gender). Etiology of cirrhosis was alcohol in most cases and indications for TIPS were mainly refractory ascites and recurrent variceal bleeding. TIPS revision was necessary in 31 patients. We identified 4 cases (2.9%) of SIC-T in direct proximity of the TIPS-stent. Diagnosis was confirmed by CT-scan, MRI or endoscopic retrograde cholangio pancreaticography (ERCP). In two patients TIPS was implanted via the right and in one through the medial hepatic vein. One patient received TIPS-prolongation by multiple revisions. Most patients were asymptomatic but one cholangitic abscess necessitated a transhepatic drain. Logistic regression analysis identified TIPS-placement other than from medial hepatic vein to right portal vein as risk factor (OR 21.0) for SIC-T.
CONCLUSION SIC-T ads to (mostly late) complications in the interventional treatment of cirrhotic portal hypertensions and can lead to cholangitic abscesses. Patients, particularly with multiple interventions, should be screened for SIC-T.
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Affiliation(s)
- Julian Nikolaus Bucher
- Department of Surgery, Munich University Hospital at Großhadern, Bavaria, Munich 81377, Germany
| | - Marcus Hollenbach
- Medical Department II–Gastroenterology, Hepatology, Infectious Diseases, Pulmonology, University of Leipzig Medical Center, Saxony, Leipzig 04103, Germany
| | - Steffen Strocka
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, Saxony, Leipzig 04103, Germany
| | - Gereon Gaebelein
- Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, Saarland, Homburg 66421, Germany
| | - Michael Moche
- Department of Diagnostic and Interventional Radiology, Bavaria, Nuernberg 90411, Germany
| | - Thorsten Kaiser
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig Medical Center, Saxony, Leipzig 04310, Germany
| | - Michael Bartels
- Department for General and Visceral Surgery, Helios Park-Klinikum Leipzig, Saxony, Leipzig 04289, Germany
| | - Albrecht Hoffmeister
- Medical Department II–Gastroenterology, Hepatology, Infectious Diseases, Pulmonology, University of Leipzig Medical Center, Leipzig 04103, Saxony, Germany
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Suhocki PV, Lungren MP, Kapoor B, Kim CY. Transjugular intrahepatic portosystemic shunt complications: prevention and management. Semin Intervent Radiol 2015; 32:123-32. [PMID: 26038620 DOI: 10.1055/s-0035-1549376] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) insertion has been well established as an effective treatment in the management of sequelae of portal hypertension. There are a wide variety of complications that can be encountered, such as hemorrhage, encephalopathy, TIPS dysfunction, and liver failure. This review article summarizes various approaches to preventing and managing these complications.
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Affiliation(s)
- Paul V Suhocki
- Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, North Carolina
| | - Matthew P Lungren
- Department of Radiology, Stanford University Medical Center, Palo Alto, California
| | - Baljendra Kapoor
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Charles Y Kim
- Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, North Carolina
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Biliary Obstruction After Transjugular Intrahepatic Portosystemic Shunt Placement in a Patient With Budd-Chiari Syndrome. ACG Case Rep J 2015; 2:101-3. [PMID: 26157927 PMCID: PMC4435373 DOI: 10.14309/crj.2015.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 10/09/2014] [Indexed: 12/18/2022] Open
Abstract
A 20-year-old male presented with 2 months of progressive abdominal distension due to ascites and Budd-Chiari syndrome. He underwent transjugular intrahepatic portosystemic shunt (TIPS) placement, but soon after had elevated liver enzymes. MRCP revealed mild left intrahepatic biliary dilatation without stones or obvious stricture. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a focal stricture due to compression by the TIPS. The stricture was dilated and a 10 Fr x 15-cm plastic stent was placed with excellent biliary drainage. The patient's symptoms and liver tests normalized within 1 week. This is the first case of biliary obstruction due to TIPS placement effectively managed by ERCP.
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Kruel CRP, Guimarães M, Chedid AD, Grezzana-Filho TMDJ, Leipnitz I, Araújo AD, Alvares-da-Silva MR, Kruel CDP. Bilhemia following transjugular intrahepatic portosystemic shunt placement (Tips): liver transplantation as a rescue procedure - case report. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 26:238-40. [PMID: 24190385 DOI: 10.1590/s0102-67202013000300016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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