Portal hypertension exacerbates intrahepatic portosystemic venous shunt and further induces refractory hepatic encephalopathy: A case report |
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Authors: | Ying-Hao Chang Xiao-Lei Zhou Dan Jing Zhen Ni Shan-Hong Tang |
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Institution: | Ying-Hao Chang, Xiao-Lei Zhou, Dan Jing, Zhen Ni, Shan-Hong Tang, Department of Gastroenterology, General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, ChinaYing-Hao Chang, Zhen Ni, Department of Infectious Diseases, General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China |
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Abstract: | BACKGROUNDIntrahepatic portosystemic venous shunt (IPSVS) is a rare hepatic disease with different clinical manifestations. Most IPSVS patients with mild shunts are asymptomatic, while the patients with severe shunts present complications such as hepatic encephalopathy. For patients with portal hypertension accompanied by intrahepatic shunt, portal hypertension may lead to hemodynamic changes that may result in exacerbated portal shunt and increased shunt flow.CASE SUMMARYA 57-year-old man, with the medical history of chronic hepatitis B and liver cirrhosis, was admitted to our hospital with abnormal behavior for 10 mo. He had received the esophageal varices ligation and entecavir therapy 1 year ago. Comparing with former examination results, the degree of esophageal varices was significantly reduced, while the right branch of the portal vein was significantly expanded and tortuous. Meanwhile, abdominal ultrasound presented the right posterior branch of portal vein connected with the retrohepatic inferior vena cava. The imaging findings indicated the diagnosis of IPSVS and hepatic encephalopathy. Instead of radiologic interventions or surgical therapies, this patient had only accepted symptomatic treatment. No recurrence of hepatic encephalopathy was observed during 1-year follow-up.CONCLUSIONHemodynamic changes may exacerbate intrahepatic portosystemic shunt. The intervention or surgery should be carefully applied to patients with severe portal hypertension due to the risk of hemorrhage. |
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Keywords: | Intrahepatic portosystemic venous shunt Portal hypertension Hepatic encephalopathy Esophageal varices Symptomatic treatment Case report Hemodynamics |
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