Recurrent Biliary Obstruction Secondary to Portal Biliopathy and the Role of Cholagioscopy: A Case Report

Portal vein thrombosis with cavernous transformation is a rare cause of biliary obstruction. Portal biliopathy is a term that refers to abnormalities in the intrahepatic and extrahepatic biliary tract, gall bladder, and cystic duct secondary to portal hypertension. Patients may be asymptomatic, but they can also present with abdominal pain, jaundice, and fever. We present the case of a 61-year-old Caucasian female who presented with generalized weakness, dark urine, and yellow skin for three days' duration. Magnetic resonance cholangiopancreatography (MRCP) showed extrahepatic and intrahepatic biliary ductal dilatation. Endoscopic retrograde cholangiopancreatography (ERCP) with cholangioscopy was used to make the diagnosis of portal biliopathy. This case highlights the importance of ERCP with cholangioscopy in the diagnosis and management of recurrent portal biliopathy.