Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 27, 2022; 14(5): 1038-1046
Published online May 27, 2022. doi: 10.4254/wjh.v14.i5.1038
Biliary obstruction following transjugular intrahepatic portosystemic shunt placement in a patient after liver transplantation: A case report
Peter Macinga, Darina Gogova, Jan Raupach, Jana Jarosova, Libor Janousek, Eva Honsova, Pavel Taimr, Julius Spicak, Jiri Novotny, Jan Peregrin, Tomas Hucl
Peter Macinga, Darina Gogova, Jana Jarosova, Pavel Taimr, Julius Spicak, Tomas Hucl, 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
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
Jiri Novotny, Jan Peregrin, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
Author contributions: Hucl T, Peregrin J and Macinga P created the conception and design of this research; Macinga P and Hucl T wrote the paper, Gogova D and Jarosova J reviewed the literature and contributed to manuscript drafting; Raupach J performed transjugular intrahepatic portosystemic shunt placement; Janousek L performed liver transplantation and provided surgical consultations; Honsova E performed histological examination; Novotny J performed percutaneous transhepatic biliary drainage and interpreted the imaging findings; Hucl T, Spicak J, Taimr P and Peregrin J were responsible for the revision of the manuscript for important intellectual content; All authors revised the manuscript and issued final approval for the version to be submitted.
Supported by Czech Health Research Council, No. 17-30281A.
Informed consent statement: The patient provided us with consent to publish his case and all relevant imaging documentation.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have prepared and revised this manuscript according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tomas Hucl, MD, PhD, Professor, Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Videnska 1958, Prague 14021, Czech Republic. tomas.hucl@ikem.cz
Received: December 22, 2021
Peer-review started: December 22, 2021
First decision: February 15, 2022
Revised: April 24, 2022
Accepted: April 24, 2022
Article in press: April 24, 2022
Published online: May 27, 2022
Processing time: 152 Days and 12.9 Hours
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.

Keywords: Biliary stricture; Transjugular intrahepatic portosystemic shunt; Liver transplantation; Sinusoidal obstruction syndrome; Literature review; Case report

Core Tip: Biliary stricture is the most unusual complication of transjugular intrahepatic portosystemic shunt (TIPS) implantation yet to be reported in liver transplant recipients. In our patient, TIPS was successfully used to treat the rare liver graft disease, sinusoidal obstruction syndrome. Cholangitis with abscess formation caused by a TIPS-induced stricture of the right hepatic duct was successfully treated by percutaneous and subsequent endoscopic drainage and resulted in preserved liver graft function. However, the stenosis persisted even after long-term endoscopic treatment. The outcome of our case is comparable to those reported in a native liver where no case was resolved using only biliary drainage.