Xu T, Lai XH, Ye QX, Liu LG, Xu ZJ. Transjugular intrahepatic portosystemic shunt via the caudate lobe portal vein due to anatomic variation: Two case reports. World J Gastrointest Surg 2026; 18(8): 120285 [DOI: 10.4240/wjgs.120285]
Corresponding Author of This Article
Zheng-Ju Xu, The Liver Disease Center, The 910th Hospital of the PLA Joint Logistics Support Force, No. 180 Huayuan Road, Fengze District, Quanzhou 362000, Fujian Province, China. h180@163.com
Research Domain of This Article
Gastroenterology & Hepatology
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case-report
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Xu T, Lai XH, Ye QX, Liu LG, Xu ZJ. Transjugular intrahepatic portosystemic shunt via the caudate lobe portal vein due to anatomic variation: Two case reports. World J Gastrointest Surg 2026; 18(8): 120285 [DOI: 10.4240/wjgs.120285]
World J Gastrointest Surg. Aug 27, 2026; 18(8): 120285 Published online Aug 27, 2026. doi: 10.4240/wjgs.120285
Transjugular intrahepatic portosystemic shunt via the caudate lobe portal vein due to anatomic variation: Two case reports
Tao Xu, Xiao-Huan Lai, Qiao-Xia Ye, Li-Guan Liu, Zheng-Ju Xu
Tao Xu, Qiao-Xia Ye, Li-Guan Liu, Zheng-Ju Xu, The Liver Disease Center, The 910th Hospital of the PLA Joint Logistics Support Force, Quanzhou 362000, Fujian Province, China
Xiao-Huan Lai, Department of Interventional Hepatology, The Fifth People’s Hospital of Ganzhou, Ganzhou 341000, Jiangxi Province, China
Co-first authors: Tao Xu and Xiao-Huan Lai.
Author contributions: Xu T and Lai XH conceived the study; Ye QX assembled and analyzed the data; Liu LG contributed to the discussion the article; Xu ZJ reviewed and edited the article; all authors read and approved the submitted manuscript. Xu T and Lai XH contributed equally to this work as co-first authors.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. The patient was informed that their personal identifiers would be removed to protect anonymity.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Zheng-Ju Xu, The Liver Disease Center, The 910th Hospital of the PLA Joint Logistics Support Force, No. 180 Huayuan Road, Fengze District, Quanzhou 362000, Fujian Province, China. h180@163.com
Received: February 26, 2026 Revised: April 8, 2026 Accepted: June 5, 2026 Published online: August 27, 2026 Processing time: 175 Days and 8.2 Hours
Abstract
BACKGROUND
The target sites for transjugular intrahepatic portosystemic shunt (TIPS) treatment of esophageal and gastric varices are typically the left and right branches of the portal vein and its confluence. In clinical practice, the puncture needle may inadvertently puncture secondary branches or other smaller branches of the portal vein. It was observed that when the caudate lobe portal vein (CLPV) was successfully targeted, a covered stent can be effectively placed.
CASE SUMMARY
This study reports two patients with esophageal and gastric variceal bleeding, who underwent successful TIPS surgery via the CLPV. Covered and bare stents were successfully placed through this rare anatomical variant vessel, and the TIPS channel was established. During the follow-up, portal vein pressure significantly decreased, and no obvious complications were observed. This study indicates that TIPS via CLPV due to anatomic variation is a feasible approach. During the puncture process, it was found that the puncture hit the portal vein of the caudate lobe, allowing for the safe placement of a covered stent without the need for re-puncture.
CONCLUSION
TIPS is safe and effective when the CLPV is used as the puncture target. The intraoperative puncture of this vein allows for the successful deployment of a covered stent, thereby completing the procedure without requiring re-puncture.
Core Tip: This study reports on two patients with esophageal and gastric varices, the successful placement of covered and bare stents through this rare caudate lobe vein (CLPV), and the establishment of a transjugular intrahepatic portosystemic shunt (TIPS) channel. During follow-up, portal vein pressure significantly decreased, with no obvious complications observed. This study demonstrates that due to anatomical variations, performing TIPS through CLPV is a feasible method.
