BILIARY-SHUNT FISTULA FOLLOWING TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT PLACEMENT

Sepsis following the placement of a transjugular intrahepatic portosys temic shunt (TIPS) has been reported in up to 10% of cases. This repor t describes an unusual case of polymicrobial gram-negative sepsis afte r placement of TIPS associated with a cholangiographically documented fistulous connection between the biliary tree and shunt, The patient w as treated with temporary biliary stent placement, endoscopic sphincte rotomy, and broad-spectrum antibiotics with rapid closure of the fistu la and resolution of sepsis, In the absence of hemobilia, it is hypoth esized 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 i s unknown. It may be a previously unsuspected source of sepsis after p lacement of TIPS and is likely to be overlooked unless endoscopic retr ograde cholangiopancreatography is performed.