Intra and Extrahepatic Cholestasis Due to Hepatic Duct Compression Caused by Cavernous Transformation of the Portal Vein: A Case Report and Literature Review

Introduction: Cavernous transformation of the portal vein (CTPV) is a rare but clinically significant vascular anomaly that often leads to portal hypertension and portal biliopathy. In CTPV, the development of a network of collateral veins occurs secondary to portal vein thrombosis, which can cause compression of the hepatic ducts. This report presents a case of intra- and extrahepatic cholestasis in a 37-year-old woman, highlighting the challenges in diagnosing and managing CTPV and its complications.

Methods: The patient presented with elevated liver enzymes and history of portal hypertension. Imaging studies, including abdominal ultrasound and MRCP, revealed common hepatic duct compression due to portal cavernoma. Endoscopic retrograde cholangiopancreatography (ERCP) was performed to manage biliary strictures. Literature review was conducted to explore current treatment options, ranging from anticoagulation therapy to endoscopic interventions.

Results: The patient exhibited significant intra- and extrahepatic bile duct dilation, with high-grade stenosis of the common hepatic duct. A stent was placed via ERCP, resulting in a marked reduction in liver enzyme levels and symptomatic relief. Follow-up ERCP three months later confirmed the persistence of biliary stenosis, requiring stent replacement. The patient remained stable without complications such as post-ERCP pancreatitis.

Discussion: This case underscores the complexity of diagnosing CTPV and managing its associated biliary strictures. ERCP proved to be an effective therapeutic tool in decompressing the bile ducts and improving liver function. Collaboration between hepatologists, radiologists, and endoscopists is crucial for successful CTPV’s management. Further research is needed to optimize treatment strategies and long-term outcomes in this rare vascular condition.

Publication History

Article published online:
20 January 2025