Biliary-shunt fistula following transjugular intrahepatic portosystemic shunt placement.

Abstract:

:Sepsis following the placement of a transjugular intrahepatic portosystemic shunt (TIPS) has been reported in up to 10% of cases. This report describes an unusual case of polymicrobial gram-negative sepsis after placement of TIPS associated with a cholangiographically documented fistulous connection between the biliary tree and shunt. The patient was treated with temporary biliary stent placement, endoscopic sphincterotomy, and broad-spectrum antibiotics with rapid closure of the fistula and resolution of sepsis. In the absence of hemobilia, it is hypothesized that flow through the fistula allowed bilious contamination of the systemic circulation and subsequent inoculation with enteric flora. The prevalence of biliary-vascular fistula after placement of TIPS is unknown. It may be a previously unsuspected source of sepsis after placement of TIPS and is likely to be overlooked unless endoscopic retrograde cholangiopancreatography is performed.

journal_name

Gastroenterology

journal_title

Gastroenterology

authors

Mallery S,Freeman ML,Peine CJ,Miller RP,Stanchfield WR

doi

10.1053/gast.1996.v111.pm8898650

subject

Has Abstract

pub_date

1996-11-01 00:00:00

pages

1353-7

issue

5

eissn

0016-5085

issn

1528-0012

pii

S001650859600491X

journal_volume

111

pub_type

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