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embolization of splenorenal shunt associated to portal vein thrombosis and hepatic encephalopathy

World Journal of Gastroenterology 2014年第42期20卷 15910-15915页

作者： Letícia de Campos Franzoni Fábio Cardoso de Carvalho Rafael Gomes de Almeida Garzon Fábio da Silva Yamashiro Laís Augusti Lívia Alves Amaral Santos Mariana de Souza Dorna Júlio Pinheiro Baima Talles Bazeia Lima Carlos Antonio Caramori Giovanni Faria Silva Fernando Gomes Romeiro Internal Medicine Department Gastroenterology Division Botucatu Medical School UNESP 18 618 970 Botucatu Sao Paulo Brazil Hospital do Cora??o do Instituto de Moléstias Cardiovasculares S?o José do Rio Preto Sao Paulo 15015-210 Brazil Department of Internal Medicine Division of Cardiology Botucatu School of Medicine UNESP Univ Estadual Paulista

Hepatic encephalopathy(HE)is a cognitive disturbance characterized by neuropsychiatric *** occurs in acute and chronic hepatic disease and also in patients with portosystemic *** presence of these portosystemic shunts allows the passage of nitrogenous substances from the intestines through systemic veins without liver ***,the embolization of these shunts has been performed tocontrol HE manifestations,but the presence of portal vein thrombosis is considered a *** this presentation we show a cirrhotic patient with severe HE and portal vein thrombosis who was submitted to embolization of a large portosystemic *** report:a 57 years-old cirrhotic patient who had been hospitalized many times for persistent HE and hepatic coma,even without precipitant *** had a wide portosystemic shunt and also portal vein *** abdominal angiography confirmed the splenorenal shunt and showed other *** larger shunt was embolized through placement of microcoils,and the patient had no recurrence of overt *** was a little increase of esophageal and gastric varices,but no endoscopic treatment was *** portosystemic shunts are frequent causes of recurrent HE in cirrhotic patients,portal vein thrombosis should be considered a relative contraindication to perform a shunt ***,in particular cases with many shunts and severe HE,we found that one of these shunts can be safely embolized and this procedure can be sufficient to obtain a good HE *** conclusion,we reported a case of persistent HE due to a wide portosystemic shunt associated with portal vein *** the patient had other shunts,she was successfully treated by embolization of the larger shunt.

关键词： Recurrent hepatic encephalopathy Liver cirrhosis Port systemic shunt shunt embolization Portal vein thrombosis

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