Liver failure after an uncovered TIPS procedure associated with hepatic infarction

Area of Science:

• Hepatology
• Interventional Radiology
• Gastroenterology

Background:

• Transjugular intrahepatic portosystemic shunt (TIPS) is a standard treatment for complications of liver cirrhosis, including refractory ascites.
• Patients with advanced liver disease (Child-Pugh C) have a higher risk of complications.
• Rare adverse events following TIPS require thorough investigation and reporting.

Purpose of the Study:

• To report a rare case of fatal liver failure following a TIPS procedure.
• To describe the clinical presentation, diagnostic findings, and outcome of hepatic infarction post-TIPS.
• To emphasize the potential risks of TIPS in patients with severely compromised liver function.

Main Methods:

• Case report of a 38-year-old male with Child-Pugh C liver cirrhosis.
• Description of the patient's clinical course and laboratory findings after TIPS placement.
• Imaging findings including non-enhanced computed tomography (CT) to assess liver parenchyma.

Main Results:

• The patient developed distributive shock, jaundice, hepatic encephalopathy, coagulopathy, and acute renal failure within 24 hours post-TIPS.
• Laboratory tests showed a 100-fold increase in aminotransferases.
• CT revealed an irregular hypodense area suggestive of hepatic infarction.

Conclusions:

• Hepatic infarction is an uncommon but serious complication of TIPS.
• This complication can significantly worsen the prognosis in patients with pre-existing severe liver dysfunction.
• Vigilant monitoring and prompt management are crucial for patients undergoing TIPS, especially those with advanced cirrhosis.