Successful treatment of recurrent hepatic encephalopathy with revision of transjugular intrahepatic portasystemic shunt and embolisation of splenorenal shunt.

Szczegóły
Abstrakt

Tytuł:: Successful treatment of recurrent hepatic encephalopathy with revision of transjugular intrahepatic portasystemic shunt and embolisation of splenorenal shunt.
Autorzy:: Krishnamurthy P; Department of Medicine, Wright State University, Dayton, Ohio, USA .; Gastroenterology, Dayton VA Medical Center, Dayton, Ohio, USA.
Ahmad A; Internal Medicine, Wright State University, Dayton, Ohio, USA.
Źródło:: BMJ case reports [BMJ Case Rep] 2021 Jun 24; Vol. 14 (6). Date of Electronic Publication: 2021 Jun 24.
Typ publikacji:: Case Reports; Journal Article
Język:: English
Imprint Name(s):: Original Publication: London : BMJ Pub. Group
MeSH Terms:: Esophageal and Gastric Varices*
Hepatic Encephalopathy*/etiology
Hepatic Encephalopathy*/therapy
Hypertension, Portal*/surgery
Portasystemic Shunt, Transjugular Intrahepatic*
Splenorenal Shunt, Surgical*
Humans ; Male ; Middle Aged ; Quality of Life ; Stents
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Contributed Indexing:: Keywords: cirrhosis; nonalcoholic steatosis; portal hypertension
Entry Date(s):: Date Created: 20210625 Date Completed: 20210628 Latest Revision: 20230701
Update Code:: 20240105
PubMed Central ID:: PMC8231032
DOI:: 10.1136/bcr-2021-242368
PMID:: 34167979
: Czasopismo naukowe

We present a case of 64-year-old US veteran who developed recurrent hepatic encephalopathy (HE) following transjugular intrahepatic portasystemic shunt (TIPSS) procedure. The patient had a history of metabolic syndrome and cirrhosis due to non-alcoholic steatohepatitis. He had undergone sleeve gastrectomy 1 year earlier with preoperative TIPSS placement. He developed recurrent symptoms of HE despite optimising his medications, resulting in poor quality of life and multiple hospitalisations. A liver Doppler ultrasound and CT scan of the abdomen was obtained which showed a patent TIPSS and a prominent shunt between the splenic vein and left renal vein via the left gonadal vein. This was treated with reduction of TIPSS, by placement of a covered stent in an hourglass configuration within the existing TIPSS stent and simultaneous embolisation of the splenorenal shunt by interventional radiology. The patient had complete resolution of symptoms following the procedure without any recurrence of HE.
Competing Interests: Competing interests: None declared.
(© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

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