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
Gastroenterologyjournal_title
Gastroenterologyauthors
Mallery S,Freeman ML,Peine CJ,Miller RP,Stanchfield WRdoi
10.1053/gast.1996.v111.pm8898650subject
Has Abstractpub_date
1996-11-01 00:00:00pages
1353-7issue
5eissn
0016-5085issn
1528-0012pii
S001650859600491Xjournal_volume
111pub_type
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