Biliary obstruction following transjugular intrahepatic portosystemic shunt placement in a patient after liver transplantation: A case report

Figure 1 Timeline of the reported case. ALC: Alcoholic liver cirrhosis; B-C: Bilio-cutaneous; I-E: Internal-external; OLTx: Orthotopic liver transplantation; RHD: Right hepatic duct; SOS: Sinusoidal obstruction syndrome.

Figure 2 Histological findings in liver biopsy. Centro lobular vein with wall edema and narrowing of the lumen by connective tissue, focal obstructive fibrosis of the surrounding sinuses; hematoxylin-eosin (A) and Elastica van Gieson (B) staining, original magnification x 100.

Figure 3 Transjugular intrahepatic portosystemic shunt implantation.

Figure 4 Magnetic resonance imaging scan after transjugular intrahepatic portosystemic shunt placement. Dilation of dorsal branch of right hepatic duct with multiple small abscesses of the right lobe.

Figure 5 Images of cholangiogram. A: Endoscopic cholangiogram. Tight stenosis in the dorsal segment of the right hepatic duct caused by the transjugular intrahepatic portosystemic shunt stent graft; stent not placed; B: Percutaneous cholangiogram. Stricture passed with a wire; external-internal catheter placed in duodenum; C: Percutaneous cholangiogram. Apparent regression of the visualized stricture with drain removed; D: Eight endoscopic cholangiograms. Persistent stricture of the right hepatic duct.