Functional recovery from refractory hepatic encephalopathy following angiographic obliteration of a large, spontaneous portal-umbilical portosystemic shunt: a case report.

Autor: Ngu NLY; Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, VIC, 3168, Australia. natalie.ngu@monash.edu.; School of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia. natalie.ngu@monash.edu., Saxby E; Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, VIC, 3168, Australia., Farmer CC; Monash Imaging, Monash Health, Clayton, Australia.; Western Health Medical Imaging, Western Health, Footscray, Australia., Lyon S; Monash Imaging, Monash Health, Clayton, Australia., Le S; Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, VIC, 3168, Australia.; School of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
Jazyk: angličtina
Zdroj: CVIR endovascular [CVIR Endovasc] 2022 Aug 24; Vol. 5 (1), pp. 45. Date of Electronic Publication: 2022 Aug 24.
DOI: 10.1186/s42155-022-00320-3
Abstrakt: Background: Hepatic encephalopathy (HE) as a consequence of cirrhosis with portal hypertension has a profound impact on quality of life for both patients and caregivers, has no gold-standard diagnostic test, and is a risk factor for mortality. Spontaneous portosystemic shunts (SPSS) are common in patients with cirrhosis, can be challenging to identify, and in some cases, can drive refractory HE. Cross-sectional shunt size greater than 83mm 2 is associated with liver disease severity, overt HE, and mortality.
Case Presentation: We report a patient with refractory HE and frequent hospitalization in the context of an occult spontaneous portal-umbilical portosystemic shunt with an estimated cross-sectional area of 809mm 2 . Following identification and angiographic retrograde transvenous obliteration of the SPSS using plugs, coils and sclerosant, there was improvement in neurocognitive testing and no further hospitalization for HE.
Conclusion: SPSS in the context of cirrhosis with portal hypertension can contribute to the debilitating effects of refractory HE. This case highlights the opportunity to search for SPSS in patients with HE unresponsive to therapy as angiographic obliteration is usually safe, well-tolerated, and clinically effective.
(© 2022. The Author(s).)
Databáze: MEDLINE
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