Bilhemia after trans-jugular intra-hepatic porto-systemic shunt and its management with biliary decompression

• Published in: World journal of gastroenterology : WJG 2009-08, Vol.15 (29), p.3681-3683
• Main Authors: Singal, Ashwani K, Kathuria, Manoj K, Malhotra, Advitya, Goodgame, Richard W, Soloway, Roger D
• Format: Article
• Language: English
• Subjects: Aged; Bile; Bilirubin - blood; Case Report; Cholangiopancreatography, Endoscopic Retrograde; Female; Humans; Portasystemic Shunt, Transjugular Intrahepatic - adverse effects; Postoperative Complications - blood; Postoperative Complications - surgery; 门静脉
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.15.3681

Bilhemia or bile mixing with blood is a rare clinical problem. The clinical presentation is usually transient self-resolving hyperbilirubinemia, progressive and rapidly rising conjugated hyperbilirubinemia, or recurrent cholangitis. Endoscopic retrograde cholangiopancreatography （ERCP） plays an important role in diagnosis and management. Biliary decompression with endoscopic sphincterotomy is useful in treating these patients. If not recognized and treated in time, the condition can be fatal in a significant proportion of patients. This usually occurs after blunt or penetrating hepatic trauma due to a fistulous connection between the biliary radicle and portal or hepatic venous radical. Cases have been described due to iatrogenic trauma such as liver biopsy and percutaneous biliary drainage. However, the occurrence after trans-jugular intra-hepatic porto-systemic shunt （TIPS） is very rare. We report a case of bilhemia presenting as rapidly rising bilirubin after TIPS. The patient was managed successfully with ERCP and removal of a blood clot from the common bile duct.