Macinga Peter, Gogova Darina, Raupach Jan, Jarosova Jana, Janousek Libor, Honsova Eva, Taimr Pavel, Spicak Julius, Novotny Jiri, Peregrin Jan, Hucl Tomas
Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic.
Department of Radiology, University Hospital, Hradec Kralove 50005, Czech Republic.
World J Hepatol. 2022 May 27;14(5):1038-1046. doi: 10.4254/wjh.v14.i5.1038.
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.
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.
Biliary strictures caused by TIPS in both transplanted and native livers seem refractory to endoscopic treatment.
经颈静脉肝内门体分流术（TIPS）是一种用于降低门静脉高压的方法。胆管狭窄是该手术相关并发症中最罕见的，此前文献仅报道过12例。这些病例均未记录支架移植物所致胆管狭窄的缓解情况。报道的唯一治愈方案是肝移植或采用先进的内镜技术通过人工胆道绕过狭窄部位。
这是首例报道的移植肝中TIPS置入术后继发胆管梗阻的病例。在我们的患者中，创建门体分流术以治疗主要表现为液体潴留的严重静脉闭塞性肝移植疾病。由于右肝管背段支架移植物所致狭窄，出现了胆汁淤积性肝损害和伴有脓肿的胆管炎，经皮引流后狭窄减轻。在经皮导管拔除失败后进行了内镜引流，导致胆皮瘘。尽管目前肝移植功能良好，但即使经过44个月的治疗，狭窄仍难以治愈。
TIPS在移植肝和天然肝中引起的胆管狭窄似乎难以通过内镜治疗。
