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Treatment of TIPS/biliary fistula-related endotipsitis with a covered stent

Paul V Suhocki1, Alastair D Smith, David A Tendler

  • 1Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710, USA. suhoc001@mc.duke.edu

Journal of Vascular and Interventional Radiology : JVIR
|May 28, 2008
PubMed

Insights

Infective endotipsitis, a recurrent infection linked to transjugular intrahepatic portosystemic shunts (TIPS), was successfully treated in a patient with a rare biliary-TIPS fistula. Prompt recognition and closure of the fistula resolved the persistent polymicrobial bacteremia.

Area of Science:

  • Hepatology
  • Interventional Radiology
  • Infectious Diseases

Background:

  • Transjugular intrahepatic portosystemic shunt (TIPS) creation is a common procedure for managing complications of portal hypertension.
  • Infective endotipsitis is a rare but serious complication characterized by recurrent bacteremia or fungemia originating from the TIPS.
  • Identifying the source of infection in endotipsitis can be challenging, often requiring advanced diagnostic techniques.

Observation:

  • A patient presented with recurrent polymicrobial bacteremia 6 years post-TIPS, unresponsive to prolonged antibiotic therapy.
  • An unusual communication (fistula) between the TIPS and an infected biliary tree, secondary to cholecystitis, was identified as the source.
  • This biliary-TIPS fistula represented a novel pathway for persistent infection.

Findings:

  • Successful treatment involved closing the biliary-TIPS fistula using a polytetrafluoroethylene-covered stent.
  • Following the intervention, the patient's blood cultures cleared, and symptoms resolved.
  • Long-term follow-up demonstrated sustained resolution of infection with low-dose oral antibiotics.

Implications:

  • This case highlights the importance of considering unusual anatomical communications in refractory infective endotipsitis.
  • Interventional closure of biliary-TIPS fistulas can be an effective treatment strategy.
  • Early recognition and management of such fistulas can prevent prolonged morbidity associated with recurrent bacteremia.

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