title: A Glasgow Tipple-transjugular intrahepatic portosystemic shunt insertion prior to Whipple resection.
abstract: Abdominal surgery performed in patients with significant liver disease and portal hypertension is associated with high mortality rates, with even poorer outcomes associated with complex pancreaticobiliary operations. We report on a patient requiring portal decompression via transjugular intrahepatic portosystemic shunt (TIPS) prior to a pancreaticoduodenectomy. The 49-year-old patient presented with pain, jaundice and weight loss. At ERCP an edematous ampulla was biopsied, revealing high-grade dysplasia within a distal bile duct adenoma. Liver biopsy was performed to investigate portal hypertension, confirming congenital hepatic fibrosis (CHF). A TIPS was performed to enable a pancreaticoduodenectomy. Prophylactic TIPS can be performed for preoperative portal decompression for patients requiring pancreatic resection. A potentially curative resection was performed when abdominal surgery was initially thought impossible. Notably, CHF has been associated with the development of cholangiocarcinoma in only four previous instances, with this case being only the second reported distal bile duct cholangiocarcinoma.
authors.affiliation: West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK salmanjabbar88@hotmail.co.uk.
authors.forename: Salman A A
authors.initials: SA
authors.lastname: Jabbar
authors.affiliation: West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK Academic Department of Surgery, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: Nigel B
authors.initials: NB
authors.lastname: Jamieson
authors.affiliation: Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Morris
authors.affiliation: Department of Pathology, Queen Elizabeth University Hospital, Glasgow, UK.
authors.forename: Karin A
authors.initials: KA
authors.lastname: Oien
authors.affiliation: Department of Pathology, Queen Elizabeth University Hospital, Glasgow, UK.
authors.forename: Fraser
authors.initials: F
authors.lastname: Duthie
authors.affiliation: West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: Colin J
authors.initials: CJ
authors.lastname: McKay
authors.affiliation: West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Carter
authors.affiliation: West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: Euan J
authors.initials: EJ
authors.lastname: Dickson