Portal biliopathy

Abstract

Portal biliopathy refers to cholangiographic abnormalities which occur in patients with portal cavernoma. These changes occur as a result of pressure on bile ducts from bridging tortuous paracholedochal, epicholedochal and cholecystic veins. Bile duct ischemia may occur due prolonged venous pressure effect or result from insufficient blood supply. In addition, encasement of ducts may occur due fibrotic cavernoma. Majority of patients are asymptomatic. Portal biliopathy is a progressive disease and patients who have long standing disease and more severe bile duct abnormalities present with recurrent episodes of biliary pain, cholangitis and cholestasis. Serum chemistry, ultrasound with color Doppler imaging, magnetic resonance imaging with magnetic resonance cholangiopancreatography and magnetic resonance portovenography are modalities of choice for evaluation of portal biliopathy. Endoscopic retrograde cholangiography being an invasive procedure is indicated for endotherapy only. Management of portal biliopathy is done in a stepwise manner. First, endotherapy is done for dilation of biliary strictures, placement of biliary stents to facilitate drainage and removal of bile duct calculi. Next portal venous pressure is reduced by formation of surgical porto-systemic shunt or transjugular intrahepatic portosystemic shunt. This causes significant resolution of biliary changes. Patients who persist with biliary symptoms and bile duct changes may benefit from surgical biliary drainage procedures (hepaticojejunostomy or choledechoduodenostomy).

Portal Cavernoma Mimicking Pancreatic Malignancy

“…However, when the injury to the biliary tree presents with an ischemic component, patients may require multiple interventions with the placement of stents throughout their lifetime. 2 , 11 Our patient’s symptoms improved after placement of a metal stent in the biliary tree. Because we don’t expect the portal cavernoma to regress, the stent was left in place, and no attempts have been made to remove it.…”

“…Approximately 30% of patients have no identifiable cause for the portal vein thrombosis. 2 Diagnosing PCC in older patients is challenging because the presentation and imaging findings are concerning for malignancy. Differentiation between these entities is key.…”

Portal Hypertensive Biliopathy in Adult Patients: Findings and Interventional Radiologic Treatment—A Single-Center Experience

“…12 The PHB changes involve the CBD, hepatic ducts, gallbladder and intrahepatic ducts and include bile ducts angulations and displacement, extrinsic shallow impressions/indentations, irregular ductal contours, and strictures associated with upstream dilatation. 21,22 Filling defects of the bile ducts can be associated with the latter, representing stones, prolapsing intraluminal varices, or clots. Asymptomatic PHB calls for regular follow-up with liver function tests and does not require any treatment.…”

Extra-Hepatic portal venous obstruction with portal biliopathy in infant presenting as neonatal cholestasis: a rare case report and review of literature

“…Findings of PTB and EHPVO can be well described by colour Doppler flow imaging, endoscopic retrograde cholangiopancreaticography (ERCP), CECT and MRI [27][28][29]. We diagnosed this case with MRCP and CECT portovenography [30,31].…”