Biliary-Venous Fistula Complicating Transjugular Intrahepatic Portosystemic Shunt Presenting with Recurrent Bacteremia, Jaundice, Anemia and Fever

Qaiser Jawaid, Zahid A. Saeed, Adrian M. Di Biscegliea, Elizabeth M. Brunt, Sanjay Ramrakhiani, Chintalapati R. Varma, Harvey Solomon

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

A 50-year-old White man with noncirrhotic portal hypertension presented with bleeding from gastric varices. Bleeding was initially managed with band ligation and subsequent transjugular intrahepatic portosystemic shunt (TIPS). Over the next few months, the patient had recurrent episodes of anemia, jaundice, fever and polymicrobial bacteremia. Computed tomography (CT) of the abdomen and chest, upper and lower endoscopy, endoscopic retrograde cholangiopancreatography (ERCP), and echocardiography failed to explain the bacteremia and anemia. Follow-up CT scan and Doppler sonography 9 months after placement showed TIPS was occluded. Repeat ERCP showed a bile leak with free run-off of contrast from the left hepatic duct into a vascular structure. The patient's status was upgraded for liver transplantation with Regional Review Board agreement and subsequently received a liver transplant. Gross examination of the native liver demonstrated a fistula between the left bile duct and the middle hepatic vein. Pathologic evaluation confirmed focal necrosis of the left hepatic duct communicating with an occluded TIPS and nodular regenerative hyperplasia consistent with noncirrhotic portal hypertension. Infection is rarely reported in a totally occluded TIPS. Biliary fistulas in patent TIPS have been treated by endoluminal stent graft and endoscopic sphincterotomy with biliary stent placement. Liver transplantation may be the preferred treatment if TIPS becomes infected following its complete occlusion.

Original languageEnglish
Pages (from-to)1604-1607
Number of pages4
JournalAmerican Journal of Transplantation
Volume3
Issue number12
DOIs
StatePublished - Dec 1 2003

Keywords

  • Biliary-venous fistula
  • Orthotopic liver transplant
  • TIPS

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