Salvage TIPS for refractory variceal bleeding after failed port-systemic shunt surgery in a patient with non cirrhotic portal hypertension

Chinmay Bera
2016 unpublished
In patients with refractory variceal bleed and well preserved liver function (Childs class A and B) surgical shunt and transjugular intrahepatic porto-systemic shunt (TIPS) are the only few options available. The long-term survival depends on the severity of underlying liver disease, rather than on the variceal bleeding per se(1). Efficacy of TIPS in preventing variceal bleed is almost similar in comparison to splenorenal shunt (SRS) which may be a more cost effective option(2). Both have been
more » ... 2). Both have been used as salvage therapy for refractory variceal bleeding. We herein report a case of re-fractory variceal bleed after failed distal spleno-renal shunt managed with emergency TIPS in a patient with non cirrhotic portal hypertension. Keyword :Refractory variceal hemorrhage , TIPS, splenorenal shunt Case: A 54 years old gentleman was admitted with history of recurrent episodes of large volume haematemesis. He was diagnosed as cryptogenic chronic liver disease (patent portal and hepatic vein with negative etiology work up) with portal hyperten-sion 6 months prior to the current admission. Despite being on regular endoscopic variceal ligation and optimum pharma-cologic therapy he had repeated episodes of UGI bleed.There was no history of jaundice , encephalopathy or ascites. There were no co-morbidities. His Childs score was 7 (class-B) and Model for End-Stage Liver Disease (MELD) score was 8. Upper GI endoscopy showed large oesophageal varices with red colour signs and moderate sized isolated gastric varix. Endoscopic variceal ligation was done for the large oe-sophageal varices. Colour Doppler abdomen revealed patent portal, splenic and renal veins. Elective porto-systemic shunt was planned in view of repeated episodes of haematemesis with preserved liver functions. Meanwhile he developed massive upper GI bleed. Emergency endoscopy showed bleeding from the post EVL ulcer. He underwent emergency proximal spleno-renal shunt along with splenectomy. On postoperative day 3 he developed