Intraperitoneal bleeding after balloon-occluded retrograde transvenous obliteration: a case report

Area of Science:

• Interventional Radiology
• Hepatology
• Vascular Surgery

Background:

• Hepatic encephalopathy, a disorder of consciousness, can stem from hepatic failure or portosystemic shunts.
• Balloon-occluded retrograde transvenous obliteration (BTO) is a recognized treatment for hepatic encephalopathy.

Observation:

• A 73-year-old woman with consciousness disturbance underwent BTO for a portosystemic shunt.
• The procedure involved coil and N-butyl 2-cyanoacrylate embolization of the shunt.
• Post-procedure, the patient experienced sudden loss of consciousness due to catheter-induced vascular injury and bleeding.

Findings:

• Emergency angiography confirmed bleeding from vascular injury.
• Hemostasis was successfully achieved using coils.
• This case underscores a rare but severe complication of BTO: intraperitoneal bleeding.

Implications:

• While BTO is effective, clinicians must be vigilant for potential complications like intraperitoneal hemorrhage.
• Prompt diagnosis and endovascular intervention are crucial for managing such bleeding events.
• This emphasizes the importance of meticulous technique during BTO procedures to minimize vascular injury.