Portal hypertensive biliopathy caused by extrahepatic portal vein obstruction
Abstract Extrahepatic portal vein obstruction is responsible for up to 40% of all cases of portal hypertension in adults and is the main cause of variceal bleedings in children (80–85%). Along with recurrent variceal bleedings, a complex of biliary tract alterations which is called «portal hypertensive biliopathy», aka «portal cavernoma cholangiopathy», may develop in these patients. Such injuries may occur in 70–100% of patients with extrahepatic portal vein obstruction. Despite the fact that these changes become symptomatic only in 5–38%, patients with clinically significant portal biliopathy require certain diagnostic and management approaches. Ischemic lesions of the biliary tract due to thrombosis in the portal system and biliary duct compression caused by portal cavernoma are considered to be in the basis of pathogenesis of portal biliopathy. Ultrasononography with color Doppler, computed and magnetic resonance tomography with contrast enhancing and endoscopic cholangiography are effective imaging techniques for diagnosis of this condition. Portocaval shunt surgery is the most effective in the management of portal bibliopathy if any shuntable vessel is available and can deliver a patient from the symptoms in 62–88%. Endoscopic treatment (bile duct stent, biliary draining, papillosphincterotomy, lithoextraction etc.) is performed if portocaval shunt surgery is impossible or insufficient, it is considered to be safe and associated with low frequency of complications. Biliodigestive drainage surgery could be recommended if portocaval shunting and endoscopic management appear to be ineffective. The use of ursodeoxycholic acid may have a positive effect in the treatment of portal biliopathy.
Keywords:portal hypertension, extrahepatic portal
vein obstruction, portal cavernoma, portal hypertensive biliopathy, portal cavernoma cholangiopathy, esophagogastric varices, portocaval shunt surgery, obstructive jaundice, cholangitis
Clin. Experiment. Surg. Petrovsky J. 2015. № 3. Р. 60–69.
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