BILLIARY OBSTRUCTION AFTER TIPS PLACEMENT IN A LIVER TRANSPLANT PATIENT

Aims:

Transjugular intrahepatic portosystemic shunt (TIPS) is a method conventionally used in portal hypertension treatment. Refractory ascites and bleeding from esophageal varices are the most common indications. Complications frequently observed include bleeding and development of liver encephalopathy, those affecting the biliary tree as bilioportal fistula and biliary stenosis are much less common. Placement of TIPS in a liver transplant patient is rare and implicate a technically challenging procedure.

Methods:

None.

Results:

A fourty year old male patient diagnosed with alcoholic cirrhosis underwent whole liver transplantation. Postoperatively, no major complications were observed and the patient was discharged early., He was admitted to our clinic with ascites and fluidothorax approximately two months later. The portosystemic gradient was 28 mmHg and gastroesophageal varices were found on gastroscopy. Liver biopsy showed microvascular damage corresponding with the diagnosis of sinusoidal obstruction syndrome (SOS). Placement of TIPs resulted in regression of ascites and fluidothorax. However, an apparent rise in cholestatic enzymes level occurred and MRCP showed dilation of the dorsal right-lobe bile ducts with parenchyma abscesses. ERCP discovered a tight stenosis of the right posterior duct caused by external impression by the previously implanted stentgraft. An attempt of bridging the stricture endoscopically with a stent was unsuccessful. Therefore, a percutaneous transhepatic extrernal-internal drainage drain was insterted resullting in resolution of cholestasis and liver abscesses.

Conclusions:

Our case report describes biliary stenosis, a rare complication of TIPS placement, which was successfully treated by percutaneous transhepatic drainage. It is the first complication of this type ever described in a liver transplant patient.