A 49 year old male, suffering from Caroli’s disease and long-standing portal vein thrombosis with cavernoma formation, presented with recurrent upper gastrointestinal bleeding from ectopic duodenal varices, uncontrolled by endoscopic and pharmacological management. Recent magnetic resonance imaging showed peri-oesophageal, perigastric (●) and periduodenal varices (*), portal cavernoma (∞) with a patent superior mesenteric vein, on a background of the known Caroli’s disease characterized by multiple parenchymal cystic dilatations of the biliary tree (ϕ) (Fig. 1). A transjugular intrahepatic portosystemic shunt (TIPS) creation was proposed after a multidisciplinary discussion. Portal cavernoma and Caroli’s disease, increasing the intraprocedural bleeding and infective risk, represent both relative contraindications for TIPS [
]. As per routine TIPS creations in our centre, real-time ultrasound guidance was used for portal vein targeting and allowed for precise puncture of the portal vein remnant avoiding rupture of the multiple liver parenchymal cystic dilatations of the biliary tree. Subsequently two coaxial e-PTFE covered stents (Viatorr®; GORE, Flagstaff, Arizona) were deployed reaching the porto-mesenteric confluence. The porto-caval pressure gradient decreased from 16 to 8 mmHg (Fig. 2). The procedure was performed without complications. The patient was discharged home 4 days after the procedure.
- Fagiuoli S.
- Bruno R.
- Debernardi Venon W.
- et al.
Consensus conference on TIPS management: techniques, indications, contraindications.
Digestive and Liver Disease. 2017; 49: 121-137
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Digestive and Liver Disease
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Consensus conference on TIPS management: techniques, indications, contraindications.Digestive and Liver Disease. 2017; 49: 121-137
Published online: May 25, 2017
© 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.