Transjugular intrahepatic portosystemic shunting (TIPS) is an established strategy for the management of complications of portal hypertension. Endoprosthetic infection ("endotipsitis") is a rare but serious and difficult-to-treat complication of TIPS placement. Here we report the occurrence of an infected thrombus complicating TIPS placement in a patient with extra-hepatic portal vein obstruction, recurrent variceal bleeding and portal biliopathy accompanied by recurrent cholangitis. Infected thrombotic material within TIPS could be removed only by employing rotational thrombectomy. This procedure revealed the presence of a biliary fistula which carried pathogens in the systemic circulation. The multiple episodes of sepsis did no longer recur following exclusion of the biliary fistula. This case highlights the possibility to use rotational thrombectomy for the management of complex cases of TIPS dysfunction.

Management of a complex transjugular intrahepatic portosystemic shunt dysfunction with endotipsitis through rotational thrombectomy / Vizzutti, Francesco; Casamassima, Emanuele; Falcone, Gianmarco; Gabbani, Giacomo; Rosi, Martina; Adotti, Valentina; Marra, Fabio; Fanelli, Fabrizio. - In: BJR CASE REPORTS. - ISSN 2055-7159. - STAMPA. - 10:(2024), pp. 1-3. [10.1093/bjrcr/uaae005]

Management of a complex transjugular intrahepatic portosystemic shunt dysfunction with endotipsitis through rotational thrombectomy

Vizzutti, Francesco
;
Casamassima, Emanuele;Falcone, Gianmarco;Gabbani, Giacomo;Rosi, Martina;Adotti, Valentina;Marra, Fabio;Fanelli, Fabrizio
2024

Abstract

Transjugular intrahepatic portosystemic shunting (TIPS) is an established strategy for the management of complications of portal hypertension. Endoprosthetic infection ("endotipsitis") is a rare but serious and difficult-to-treat complication of TIPS placement. Here we report the occurrence of an infected thrombus complicating TIPS placement in a patient with extra-hepatic portal vein obstruction, recurrent variceal bleeding and portal biliopathy accompanied by recurrent cholangitis. Infected thrombotic material within TIPS could be removed only by employing rotational thrombectomy. This procedure revealed the presence of a biliary fistula which carried pathogens in the systemic circulation. The multiple episodes of sepsis did no longer recur following exclusion of the biliary fistula. This case highlights the possibility to use rotational thrombectomy for the management of complex cases of TIPS dysfunction.
2024
10
1
3
Goal 3: Good health and well-being
Vizzutti, Francesco; Casamassima, Emanuele; Falcone, Gianmarco; Gabbani, Giacomo; Rosi, Martina; Adotti, Valentina; Marra, Fabio; Fanelli, Fabrizio...espandi
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1388385
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