The Role of Transjugular Intrahepatic Portosystemic Shunt in Management of Peribiliary Varices

Peribiliary varices are a rare complication of chronic portal hypertension and can lead to common bile duct narrowing. Because of this, they can complicate the management of biliary obstruction secondary to choledocholithiasis. Instrumentation such as during endoscopic retrograde cholangiopancreatography poses the risk of severe hemorrhage. As such, decompressing the portal circulation via methods such as transjugular intrahepatic portosystemic shunt before attempted biliary stone extraction and sphincterotomy may be necessary to facilitate safe and successful treatment. This case demonstrates the crucial role of transjugular intrahepatic portosystemic shunt placement in enabling successful intervention in a challenging scenario where peribiliary varices obstructed access to the common bile duct.