Case Report
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Aug 7, 2009; 15(29): 3681-3683
Published online Aug 7, 2009. doi: 10.3748/wjg.15.3681
Bilhemia after trans-jugular intra-hepatic porto-systemic shunt and its management with biliary decompression
Ashwani K Singal, Manoj K Kathuria, Advitya Malhotra, Richard W Goodgame, Roger D Soloway
Ashwani K Singal, Advitya Malhotra, Richard W Goodgame, Roger D Soloway, Division of Gastroenterology, University of Texas Medical Branch, Galveston, TX 77586-0764, United States
Richard W Goodgame, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77586-0764, United States
Manoj K Kathuria, Department of Interventional Radiology, University of Texas Medical Branch, Galveston, TX 77586-0764, United States
Author contributions: Singal AK prepared the manuscript; Kathuria MK and Malhotra A provided the figures; Goodgame RW and Soloway RD reviewed and advised on the manuscript.
Correspondence to: Ashwani K Singal, MD, Division of Gastroenterology, University of Texas Medical Branch, Galveston, TX 77586-0764, United States. aksingal@utmb.edu
Telephone: +1-409-7721501
Fax: +1-409-7724789
Received: April 3, 2009
Revised: May 24, 2009
Accepted: May 31, 2009
Published online: August 7, 2009
Abstract

Bilhemia or bile mixing with blood is a rare clinical problem. The clinical presentation is usually transient self-resolving hyperbilirubinemia, progressive and rapidly rising conjugated hyperbilirubinemia, or recurrent cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) plays an important role in diagnosis and management. Biliary decompression with endoscopic sphincterotomy is useful in treating these patients. If not recognized and treated in time, the condition can be fatal in a significant proportion of patients. This usually occurs after blunt or penetrating hepatic trauma due to a fistulous connection between the biliary radicle and portal or hepatic venous radical. Cases have been described due to iatrogenic trauma such as liver biopsy and percutaneous biliary drainage. However, the occurrence after trans-jugular intra-hepatic porto-systemic shunt (TIPS) is very rare. We report a case of bilhemia presenting as rapidly rising bilirubin after TIPS. The patient was managed successfully with ERCP and removal of a blood clot from the common bile duct.

Keywords: Bilhemia; Biliary-venous fistula; Portal vein-biliary fistula; Trans-jugular intrahepatic shunt