A common bile duct bump

Portal cavernoma cholangiopathy (PCC) is a complication of long-standing portal vein thrombosis. Biliary changes including cholestasis along with symptoms of long-standing jaundice and right upper quadrant pain are seen. Compression of the bile duct by the porto-portal collateral veins, new vessel formation due to thrombosis and the resulting ischemia from deficient blood supply as well as thrombosis in the new smaller vessels is the primary mechanism of injury.¹ There might be more than one cause and biliary obstruction can be seen at multiple levels. PCC in symptomatic patients requires multiple endoscopic interventions and surgery. The current diagnostic and therapeutic approach remains ambiguous, resulting in prolonged hospital stay, multiple imaging modalities and multiple interventions.