title: Treatment of TIPS/biliary fistula-related endotipsitis with a covered stent.
abstract: "Infective endotipsitis" describes a recurrent bacteremia or fungemia in patients with a transjugular intrahepatic portosystemic shunt (TIPS) in place and no other identifiable source of infection. The present report describes a patient who developed polymicrobial endotipsitis 6 years after TIPS creation. Blood cultures remained positive for polymicrobial growth despite long courses of antibiotic therapy. Communication between the TIPS and an infected biliary tree, precipitated by cholecystitis, was ultimately recognized. The biliary/TIPS fistula was closed with a polytetrafluoroethylene-covered stent. The patient remains asymptomatic and follow-up blood cultures remain negative with a low dose of oral antibiotics 2 years after the procedure.
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710, USA. suhoc001@mc.duke.edu
authors.forename: Paul V
authors.initials: PV
authors.lastname: Suhocki
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Smith
authors.forename: David A
authors.initials: DA
authors.lastname: Tendler
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sexton
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology; D017081:Cholecystectomy, Laparoscopic; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy*; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000601:surgery; D008297:Male; D010195:Pancreatitis / Q000601:surgery; D011138:Polytetrafluoroethylene; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*; D015607:Stents; D018608:Ultrasonography, Doppler
chemical_list: D000900:Anti-Bacterial Agents; D011138:Polytetrafluoroethylene