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Tipsitis: incidence and outcome-a single centre experience.

Narendra Kochar1, Dhiraj Tripathi, Nikolaas J Arestis

  • 1Departments of Hepatology, Royal Infirmary of Edinburgh, Edinburgh, UK. nkochar@staffmail.ed.ac.uk

European Journal of Gastroenterology & Hepatology
|May 5, 2010
PubMed
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Tipsitis, infection of transjugular intrahepatic portosystemic stent shunts (TIPSS), is rare but serious. Suspect Tipsitis in TIPSS patients with unexplained bacteraemia; prolonged antibiotics are often needed.

Area of Science:

  • Interventional Radiology
  • Infectious Diseases
  • Hepatology

Background:

  • Infection of transjugular intrahepatic portosystemic stent shunts (TIPSS), termed 'Tipsitis', is an uncommon complication.
  • This study reports institutional experience with diagnosed cases of Tipsitis.

Purpose of the Study:

  • To describe the incidence, clinical characteristics, and outcomes of Tipsitis.
  • To identify potential risk factors and management strategies for Tipsitis.

Main Methods:

  • Retrospective single-center study of patients with TIPSS.
  • Inclusion criteria: TIPSS patients with unexplained sustained bacteraemia.
  • Data collected on TIPSS indication, shunt status, duration to Tipsitis, causative organisms, treatment, and outcomes.

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Main Results:

  • Eight out of 785 (1%) TIPSS patients developed Tipsitis over 14 years.
  • Indications for TIPSS were primarily variceal bleeding (7/8).
  • Median time to Tipsitis was 21.6 months; 4/8 shunts were occluded at diagnosis. Organisms included E. coli, S. aureus. Five patients died, with Tipsitis contributing to death in three.

Conclusions:

  • Tipsitis is a rare but severe complication of TIPSS, necessitating a high index of suspicion in patients with unexplained bacteraemia.
  • Shunt interventions and overlapping stents may be risk factors.
  • Prolonged antibiotic therapy is typically required, but recurrence can occur.