Persistent Encephalopathy in a Noncirrhotic Patient: Do not Shun This Shunt

Area of Science:

• Vascular Surgery
• Hepatology
• Neurology

Background:

• Portosystemic shunts are abnormal vascular connections allowing portal blood to bypass the liver.
• They are typically associated with portal hypertension and underlying liver disease.

Observation:

• A case of a large, spontaneous intrahepatic portosystemic shunt in a patient without cirrhosis is presented.
• This shunt contributed to recurrent hepatic encephalopathy, also known as type B encephalopathy.

Findings:

• Spontaneous intrahepatic portosystemic shunts can occur in noncirrhotic patients.
• These shunts can be a significant cause of hepatic encephalopathy.

Implications:

• Diagnosis and management of spontaneous portosystemic shunts are crucial for patients with unexplained hepatic encephalopathy.
• Endovascular occlusion of the shunt is an effective treatment strategy for portosystemic encephalopathy.