60

Portal cavernoma cholangiopathy is identified by the presence of a biliary tract anomaly in a portal cavernoma context. Its pathophysiology is complex and is not limited to simple compressive phenomena. It is frequently identified during imaging, but is only symptomatic in 20 percent of cases. The clinical manifestations are those of any biliary obstruction: jaundice, lithiasis, acute cholitis. MRI is the best imaging tool for assessing the exact delineation of the varicose collaterals, the extension of the thrombus, and the damage to the bile ducts. Treatments, which are only interventional, should be reserved for symptomatic conditions. Endoscopy is of primary importance in order to remove the biliary obstacle via ERCP. Interventional radiology, via portal recanalization with or without TIPS, and surgical portosystemic shunts enable both the removal of portal hypertension, and the treatment of its other consequences (esophageal variceal rupture, ascites, and so on). In exceptional cases, liver transplantation may be proposed in cases of secondary biliary cirrhosis.