[A case of refractory hepatic encephalopathy effectively treated with partial splenic embolization]

A 59-year-old woman presented with frequent episodes of hepatic encephalopathy due to cirrhosis caused by primary biliary cholangitis and a large splenorenal shunt, leading to repeated hospital admissions. We administered maximal medical therapy and enemas to prevent constipation, but her situation did not improve. Subsequently, balloon-occluded retrograde transvenous obliteration (BRTO) was considered;however, because the splenorenal shunt was large and liver function was poor (Child-Pugh C), BRTO might have caused a sudden rise in portal venous pressure and uncontrolled ascites. Therefore, we performed partial splenic artery embolization (PSE), embolizing 43% of the splenic volume, mainly in the lower portion. After PSE, her blood-ammonia level fell and consciousness improved. Since then, she has been hospitalized only once for recurrent encephalopathy. PSE-commonly used for hypersplenism or portal hypertension-decreases splenic venous return and portal pressure, thereby reducing splenorenal-shunt flow and directing ammonia-laden blood to the liver. Thus, PSE is a useful treatment option for hepatic encephalopathy, particularly in patients with large portosystemic shunts.