transjugular intrahepatic portosystemic shunt occlusion complicated with biliary fistula successfully treated with a stent graft: a case report

a 43-year-old man with liver cirrhosis received transjugular intrahepatic portosystemic shunt (tips) for the treatment of recurrent variceal bleeding and f3 esophageal varices. during routine follow up liver ultrasound examination, six months after the implantation, tips occlusion was suspected and tips revision was performed. during the revision, moderate to severe stenosis at the hepatic venous segment of the tract and a total occlusion at the parenchymal segment of tips tract near the portal vein with biliary-tips fistula were identified with a clear visualization of the common bile duct. after the successful tips revision with the placement of an additional stent-graft, the biliary fistula and common bile duct were no more delineated. we herein report a rare case with an obvious visualization of biliary-tips fistula associated with obstruction of tips shunt on the tractogram and recanalization with an additional stent-graft.