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

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Case report
Successful treatment of recurrent hepatic encephalopathy with revision of transjugular intrahepatic portasystemic shunt and embolisation of splenorenal shunt
  1. Padmini Krishnamurthy1,2 and
  2. Ammar Ahmad3
  1. 1Department of Medicine, Wright State University, Dayton, Ohio, USA
  2. 2Gastroenterology, Dayton VA Medical Center, Dayton, Ohio, USA
  3. 3Internal Medicine, Wright State University, Dayton, Ohio, USA
  1. Correspondence to Dr Padmini Krishnamurthy; padmini.krishnamurthy{at}va.gov

Abstract

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.

  • portal hypertension
  • cirrhosis
  • nonalcoholic steatosis

https://doi.org/10.1136/bcr-2021-242368

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    • Contributors PK: obtaining data, reviewing and editing of manuscript. AA: obtaining data and Writing up the case report.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.