Liver failure after an uncovered TIPS procedure associated with hepatic infarction |
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Authors: | López-Méndez Eric Zamora-Valdés Daniel Díaz-Zamudio Mariana Fernández-Díaz Oscar F Avila Lourdes |
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Institution: | Eric López-Méndez, Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubirán (INCMNSZ), Vasco de Quiroga 15, Zip Code 14000, Mexico City, Mexico. |
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Abstract: | Transjugular intrahepatic portosystemic shunt (TIPS) is a safe and effective procedure for the treatment of complications of liver cirrhosis, such as refractory ascites, hepatic hydrothorax and refractory variceal bleeding. The aim of this paper is to describe a rare case of liver failure after a TIPS procedure. A 38-year-old diabetic male with Child-Pugh C liver cirrhosis due to chronic hepatitis C infection who had developed refractory ascites was scheduled for a TIPS procedure. Within 24 h following TIPS placement, the patient developed distributive shock, jaundice, persistentgrade 3 hepatic encephalopathy, severe coagulopathy and acute renal failure. He was treated with lactulose enemas, broad-spectrum antibiotics and blood-derived products. Laboratory data revealed a 100-fold increase in aminotransferases and a non-enhanced computed tomography showed an irregular hypodense area in the right posterior segment of the liver. Despite being initially being in a stable condition, the patient developed progressive liver failure and died 2 mo later. Hepatic infarction is an uncommon phenomenon after a TIPS procedure; however, it can greatly complicate the course of a disease in a patient with an already compromised liver function. |
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Keywords: | Hepatic ischemia Ischemic hepatitis Liver infarction Transjugular intrahepatic portosystemic shunt Complications |
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