Related Experiment Video
Updated: Sep 5, 2025
New Thrombectomy Technique for Total Portal Vein Thrombosis in Liver Transplantation
Published on: June 27, 2025
Two cases of portal-systemic encephalopathy caused by multiple portosystemic shunts successfully treated with
Yusuke Watanabe1,2,3, Akihiko Osaki4, Shun Yamazaki4
1Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan. ywatanabe19840421@med.niigata-u.ac.jp.
Insights
Percutaneous transhepatic obliteration effectively controlled portal-systemic encephalopathy in two cirrhotic patients with complex portosystemic shunts. This minimally invasive procedure offers a viable treatment option for managing hepatic encephalopathy.
Area of Science:
- Hepatology
- Interventional Radiology
- Gastroenterology
Background:
- Portal-systemic encephalopathy (PSE) is a serious complication of cirrhosis, often caused by portosystemic shunts.
- Percutaneous transhepatic obliteration (PTO) is an interventional technique used to manage PSE.
- Successful PTO can improve outcomes for cirrhotic patients with portosystemic shunts.
Observation:
- Two cases of recurrent PSE in cirrhotic patients with complex portosystemic shunts are presented.
- Case 1 involved a mesocaval shunt and paraumbilical vein, treated with coils and ethanolamine oleate-iopamidol.
- Case 2 involved multiple shunts (left gastric, intrahepatic to inferior phrenic, paraumbilical) treated with coils, ethanolamine oleate-iopamidol, and N-butyl-2-cyanoacrylate.
Findings:
- Both patients experienced successful obliteration of their portosystemic shunts via PTO.
- Portal-systemic encephalopathy became controllable in both cases following the procedure.
- PTO demonstrated effectiveness even in cases with multiple and complex shunt pathways.
Implications:
- Percutaneous transhepatic obliteration is a valuable therapeutic option for managing complex portosystemic encephalopathy.
- Careful consideration of indications is necessary due to the invasive nature of PTO.
- These successful cases provide a reference for future PTO treatments in similar complex shunt scenarios.
Background:
Portal-systemic encephalopathy is a hepatic encephalopathy caused by portosystemic shunts and is a poor prognostic factor for cirrhotic patients. Percutaneous transhepatic obliteration is an option for controlling portal-systemic encephalopathy. We report two cases of portal-systemic encephalopathy that were successfully controlled with percutaneous transhepatic obliteration.
Case Presentation:
(Case 1) A 70-year-old woman experienced repeated portal-systemic encephalopathy due to a mesocaval shunt and a paraumbilical vein. She underwent percutaneous transhepatic obliteration with coils and 5% ethanolamine oleate-iopamidol. After treatment, portal-systemic encephalopathy became controllable. (Case 2) A 60-year-old man experienced repeated portal-systemic encephalopathy due to a left gastric vein shunt, a shunt from the posterior branch of the intrahepatic portal vein to the inferior phrenic vein, and a paraumbilical vein. He underwent percutaneous transhepatic obliteration of three portosystemic shunts with coils, 5% ethanolamine oleate-iopamidol, and N-butyl-2-cyanoacrylate. After treatment, the portal-systemic encephalopathy became controllable.
Conclusions:
Percutaneous transhepatic obliteration is particularly effective in cases involving multiple and complex portosystemic shunt pathways; however, percutaneous transhepatic obliteration is an invasive treatment, and its indications should be carefully considered. These cases will serve as a reference for successful treatment in the future cases.
More Related Videos
09:02Percutaneous Hepatic Perfusion PHP with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver
Published on: July 31, 2016
07:44Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
