We read with interest the article by Khuroo et al. (1) describing biliary abnormalities associated with extrahepatic portal venous obstruction (EHPVO). Among 21 consecutive patients with EHPVO, 17 underwent endoscopic retrograde cholangiography that precisely described abnormalities involving the common bile duct or hepatic bile ducts. Most of the patients had anicteric and asymptomatic cholestasis, whereas only three had clinical symptoms of biliary tract disease (two, extrahepatic bile duct obstruction; one, recurrent cholangitis).
We had recently reported three documented cases of biliary tract compression caused by cavernous transformation of the portal vein (2). Two patients were adults and had extrahepatic bile duct obstruction first noted as cholangitis or asymptomatic cholestasis. The third patient was 11 yr old and was first seen with obstructive jaundice. Endoscopic retrograde cholangiography showed that the compression was located in two cases on the common bile duct and in the other one on the common hepatic bile duct. Cholangiographical findings were typically those described by Khuroo et al.: marginal irregularity of the bile ducts probably caused by extraluminal impression of collateral veins, smooth tapering strictures with upstream dilation. In the third (child) patient, the responsibility of the portal cavernoma was positively determined by the disappearance of jaundice after splenorenal surgical shunt.
Biliary disease is not a recognized clinical manifestation of EHPVO. We have found only 14 clinical cases in the literature. Some of those cases are old and poorly documented, only diagnosed during laparotomy.