Voor het beoordelen van een radiologisch onderzoek is het belangrijk dat je een aantal algemene kenmerken controleert (tabel 17.1 voor een conventionele roöntgenfoto en tabel 17.5 voor een CT-scan). Hierna kan de tabel van het betreffende onderzoek stapsgewijs van boven naar beneden worden doorlopen om afwijkingen te achterhalen. Leer jezelf aan om dit elke keer volledig en op dezelfde manier te doen. Vragen over het indicatiegebied voor de diverse beeldvormende onderzoeken kunnen het best in overleg met de radioloog worden opgelost.

Four patients, three men aged 51, 45 and 31 and a woman aged 22 years with portal vein thrombosis presented with symptoms or signs of biliary obstruction. Laboratory examination showed cholestasis. Cholangiography demonstrated smooth indentations of the common bile duct consistent with external compression by collateral veins. The clinical course varied from spontaneous resolution of both symptoms and serum biochemical abnormalities to persistent cholestasis. In two patients, surgical treatment (splenorenal shunt and hepaticojejunostomy) failed due to the presence of numerous collateral veins. Biliary strictures secondary to formation of a portal cavernoma, so-called portal biliopathy, is a rather unknown complication of portal vein thrombosis. Although the majority of patients is asymptomatic, porto-systemic shunt surgery or endoscopic biliary intervention may be indicated in symptomatic cases.

ter Bora, P. C.J.; van Donselaar, M.; Laméris, J. S.; Vleggaar, F. P.; Groeneweg, M.; Hop, W. C.J.; van Buuren, H. R. Author Information

We reported the case of a patient in whom severe, and ultimately fatal, pulmonary hypertension developed 1.5 yrs after transjugular intrahepatic portosystemic shunt (TIPS).Pulmonary artery pressures were not affected by 100% oxygen, prostacyclin or nifedipine, Postmortem examinations showed pulmonary and vascular abnormalities typical of pulmonary hypertension.Pulmonary artery pressures should be measured in each patient with otherwise not readily explained dyspnoea following transjugular intrahepatic portosystemic shunt.

OBJECTIVETo analyse the results in 31 patients who underwent transjugular intrahepatic portosystemic shunting (TIPS).DESIGNRetrospective study.SETTINGUniversity Hospital Rotterdam-Dijkzigt, Rotterdam, the Netherlands.METHODData of all patients who underwent a TIPS procedure from February 1992 to September 1994 were analysed. Indications for TIPS included recurrent variceal bleedings and refractory ascites. TIPS was performed under general anaesthesia. After TIPS heparin was given during one week.RESULTSTIPS creation succeeded in 29 out of 31 patients. The mean portosystemic pressure gradient after TIPS was 9.6 mmHg. After 1.5 years the cumulative percentage of recurrent variceal bleeding was 44. The quantity of ascites decreased in 73% of the patients. During recatheterisation shunt dysfunction was seen in 16 out of 21 patients. Mortality was 13% within 30 days. The actuarial percentage of patients who died was 43 after 1.5 years. Mortality depended on Child-Pugh classification.CONCLUSIONTIPS is a new, safe and fast treatment for patients with complications of portal hypertension. The number of recurrent variceal bleedings was substantial. Intensive control examinations are imperative to discern shunt dysfunction. Long-term survival rates and morbidity depend on the seriousness of the pre-existing liver disease.

Is transjugular intrahepatic portosystemic shunt (TIPS) preferable to a surgical shunting procedure in patients who are expected to benefit from a portal-systemic shunt? Since randomized trials comparing these procedures have not yet been reported, we attempted to define the present best therapeutic strategy by reviewing both the recent literature on TIPS and surgical shunting and our first experience with TIPS. The results suggest that TIPS is just as effective as surgical shunting but is associated with a lower morbidity and mortality. Procedure related deaths seem rare. In our scries of 16 patients there was one death within 30 days. Seven early complications including stent dislodgement, early occlusion, encephalopathy and haemolysis were noted. The incidence of long-term complications, especially encephalopathy and shunt occlusion, seems comparable for both shunting procedures. Major advantages of TIPS are its therapeutic efficacy in patients with ascites and the fact that the technical difficulties of performing liver transplantation are not increased. We conclude that TIPS, performed by an experienced team, is at present the procedure of choice in patients who are candidates for a portal-systemic shunt, especially in patients in whom liver transplantation is a future option. Surgical shunts can be reserved for patients in whom TIPS is not feasible or has failed.

Is transjugular intrahepatic portosystemic shunt (TIPS) preferable to a surgical shunting procedure in patients who are expected to benefit from a portal-systemic shunt? Since randomized trials comparing these procedures have not yet been reported, we attempted to define the present best therapeutic strategy by reviewing both the recent literature on TIPS and surgical shunting and our first experience with TIPS. The results suggest that TIPS is just as effective as surgical shunting but is associated with a lower morbidity and mortality. Procedure related deaths seem rare. In our series of 16 patients there was one death within 30 days. Seven early complications including stent dislodgement, early occlusion, encephalopathy and haemolysis were noted. The incidence of long-term complications, especially encephalopathy and shunt occlusion, seems comparable for both shunting procedures. Major advantages of TIPS are its therapeutic efficacy in patients with ascites and the fact that the technical difficulties of performing liver transplantation are not increased. We conclude that TIPS, performed by an experienced team, is at present the procedure of choice in patients who are candidates for a portal-systemic shunt, especially in patients in whom liver transplantation is a future option. Surgical shunts can be reserved for patients in whom TIPS is not feasible or has failed.