RECURRENT URINARY CONDUIT BLEEDING IN A PATIENT WITH PORTAL-HYPERTENSION - MANAGEMENT WITH A TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT

Objective. To determine if a transjugular intrahepatic portosystemic s hunt can control recurrent urinary conduit bleeding in a patient with portal hypertension. Methods. Following transjugular catheterization o f the right hepatic vein, a long curve Colapinto needle was advanced t hrough the liver parenchyma into the portal vein near its bifurcation. After a guide wire exchange, a catheter was advanced into the portal system and venogram was obtained. Following another guide wire exchang e, a balloon angioplasty catheter was used to create the shunt by dila ting the parenchymal tract between the hepatic and portal veins. A sel f-expandable stent was used to ensure patency of the shunt. Results. A fter shunt placement, bleeding from the ileal conduit and stoma decrea sed significantly. A duplex ultrasound at five-month follow-up demonst rated the shunt to be completely patent. Conclusions. Based on this li mited experience, it appears that the transjugular, intrahepatic, port osystemic shunt is an acceptable method to control massive, recurrent urinary conduit bleeding in patients with portal hypertension.