[Emergency intrahepatic shunt via transjugular approach]

We report the case of a cirrhotic 65 year-old woman presenting with persistent and recurrent variceal hemorrhage in spite of endoscopic sclerotherapy with bucrylate, glypressin infusion and balloon tamponade. At the time of intrahepatic shunt placement via the transjugular route, Child-Pugh score was 14 (Child C category) and surgical variceal decompression or liver transplantation were contraindicated. At the end of the procedure, which included the placement of two Palmaz stents, varices were no more opacified and the wedge hepatic venous pressure gradient had decreased from 70%. Evolution of the patient was excellent with a permeable shunt after one month. Emergency placement of intrahepatic shunt with metallic stent has certainly a place in case of failure of initial management of variceal bleeding with pharmacotherapy, sclerotherapy or balloon tamponade.