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Persistent hepatic encephalopathy secondary to portosystemic shunt occluded with Amplatzer device

Ariadna Ramírez-Polo1, Ernesto Márquez-Guillén1, Adrián J González-Aguirre2

  • 1Department of Gastroenterology, National Institute of Medical Sciences and Nutrition, Salvador Zubirán, (INCMNSZ), Mexico City, Mexico.

Annals of Hepatology
|June 14, 2014
PubMed

Insights

Persistent hepatic encephalopathy in cirrhosis patients can stem from rare portosystemic shunts. This case highlights successful treatment of a porto-onfalo-femoral shunt using an Amplatzer device, resolving persistent hepatic encephalopathy.

Area of Science:

  • Hepatology
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Hepatic encephalopathy is a common complication of cirrhosis.
  • Persistent hepatic encephalopathy necessitates verification of treatment compliance and identification of precipitating factors.
  • Rarely, portosystemic shunts can cause decompensation or persistent hepatic encephalopathy.

Observation:

  • A 57-year-old male presented with persistent hepatic encephalopathy.
  • The patient was found to have a porto-onfalo-femoral shunt.
  • This shunt was identified as the cause of the persistent hepatic encephalopathy.

Findings:

  • The porto-onfalo-femoral shunt was successfully closed using an Amplatzer device.
  • Closure of the shunt led to the resolution of the patient's persistent hepatic encephalopathy.

Implications:

  • This case highlights the importance of considering and ruling out portosystemic shunts in refractory hepatic encephalopathy.
  • Endovascular closure with devices like the Amplatzer offers a viable treatment option for such shunts.
  • Successful management of portosystemic shunts can significantly improve outcomes for patients with cirrhosis and persistent HE.

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