Spontaneous portosystemic shunts in noncirrhotic patients presenting with encephalopathy

Portosystemic shunts (PSS) are common in patients with chronic liver disease and portal hypertension, however, their occurrence in noncirrhotic individuals is likely under appreciated. Patients may present with symptoms of hepatic encephalopathy and/or gastrointestinal bleeding and undergo extensive work up for liver disease to no avail. Often, these patients suffer for years with accruing medical expenses and numerous hospitalizations related to repeated episodes of encephalopathy. The underlying cause may go undiagnosed or misdiagnosed as occult hepatic dysfunction or even a neuropsychological disorder. In many cases, abdominal CT imaging demonstrates the abnormal portosystemic connection well before it is recognized as the cause of symptoms. In this brief report, we discuss three cases presenting with symptoms of encephalopathy and report successful management with endovascular occlusion of the portosystemic shunts.