Biliary Obstruction After Transjugular Intrahepatic Portosystemic Shunt Placement

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.

A Comprehensive Review of Transjugular Intrahepatic Portosystemic Shunt–Related Complications

“…5,[19][20][21] The postulated mechanism for biliary obstruction is an external compression of the bile ducts by the stent; however, actual perforation of the common bile duct by the stent has been reported. 22 Biliary dilatation eventually leads to atrophy of the affected segment. Very rarely the stagnant bile can get infected and lead to recurrent cholangitis and bacteremia that may require endoscopic or percutaneous biliary drainage (►Fig.…”