Guidelines For Clinical Practice
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World J Gastroenterol. Jul 14, 2012; 18(26): 3375-3378
Published online Jul 14, 2012. doi: 10.3748/wjg.v18.i26.3375
How can portal vein cavernous transformation cause chronic incomplete biliary obstruction?
Ozgur Harmanci, Yusuf Bayraktar
Ozgur Harmanci, Yusuf Bayraktar, Department of Medicine, Division of Gastroenterology, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey
Author contributions: Harmanci O and Bayraktar Y contributed equally to this paper.
Correspondence to: Dr. Ozgur Harmanci, MD, Department of Medicine, Division of Gastroenterology, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey.
Telephone: +90-312-3051714  Fax: +90-312-3051490
Received: November 2, 2011
Revised: February 27, 2012
Accepted: March 19, 2012
Published online: July 14, 2012

Biliary disease in the setting of non-cirrhotic portal vein thrombosis (and similarly in portal vein cavernous transformation) can become a serious problem during the evolution of disease. This is mostly due to portal biliary ductopathy. There are several mechanisms that play a role in the development of portal biliary ductopathy, such as induction of fibrosis in the biliary tract (due to direct action of dilated peribiliary collaterals and/or recurrent cholangitis), loss of biliary motility, chronic cholestasis (due to fibrosis or choledocholithiasis) and increased formation of cholelithiasis (due to various factors). The management of cholelithiasis in cases with portal vein cavernous transformation merits special attention. Because of a heterogeneous clinical presentation and concomitant pathophysiological changes that take place in biliary anatomy, diagnosis and therapy can become very complicated. Due to increased incidence and complications of cholelithiasis, standard treatment modalities like sphincterotomy or balloon sweeping of bile ducts can cause serious problems. Cholangitis, biliary strictures and hemobilia are the most common complications that occur during management of these patients. In this review, we specifically discuss important issues about bile stones related to bile duct obstruction in non-cirrhotic portal vein thrombosis and present evidence in the current literature.

Keywords: Portal vein cavernous transformation, Cholelithiasis, Hemobilia, Portal ductopathy, Portal biliopathy