BILE-DUCT OBSTRUCTION DUE TO PORTAL BILIOPATHY IN EXTRAHEPATIC PORTAL-HYPERTENSION - SURGICAL-MANAGEMENT

Background Varices can develop in and around the bile duct in the pres ence of portal hypertension, especially when it is caused by extrahepa tic portal vein thrombosis. The term 'portal biliopathy' is used to de scribe changes in the bile duct due to these varices, which may cause bile duct obstruction. This paper reviews experience of the surgical m anagement of patients with symptomatic portal biliopathy. Methods Nine patients with extrahepatic portal vein obstruction with symptomatic p ortal biliopathy were reviewed retrospectively. Results Eight patients presented with jaundice, two had abdominal pain and one had recurrent cholangitis. Endoscopic retrograde cholangiography revealed abnormali ty of the bile duct wall, with stricture in eight patients and bile du ct calculi in two. Portasystemic shunting relieved jaundice in five of seven patients, and in two a second-stage hepaticojejunostomy was req uired. Conclusion Symptomatic biliary obstruction in patients with ext rahepatic portal hypertension may be relieved by a portasystemic shunt . Rarely biliary bypass may be required and is rendered safer by previ ous portasystemic shunting to decompress the pericholedochal varices. A direct approach to the biliary tract without a preliminary shunt may be hazardous and is frequently unnecessary.