Biliary changes in extrahepatic portal venous obstruction: Compression by collaterals or ischemic?

摘要: Background: The postulated mechanisms of biliary abnormalities in extrahepatic portal venous obstruction (EHPVO) are either extrinsic compression by collaterals or ischemic injury due to thrombosis. If the former hypothesis is correct, then changes should revert normal after portasystemic shunt surgery. Methods: Five patients with EHPVO who underwent surgery were studied. One these had obstructive jaundice cavernoma. Endoscopic retrograde cholangiography (ERC) was performed before as well Doppler ultrasound and splenoportovenography obtained confirm diagnosis patency. Results: All on pre-shunt ERC. post-shunt ERC showed partial reversal 3 patients, complete 1 patient, no patient. Smooth strictures opened proximal dilatation disappeared most patients. indentations caliber irregularities surgery, whereas angulations ectasias ducts persisted. Conclusion: Shunt results regression some relieves obstruction, suggesting that mechanical mechanism behind EHPVO. However, persist signifying fixed ischemia fibrous scarring. Thus, two theories not mutually exclusive.