Extra-hepatic portosystemic shunt leading to encephalopathy in a noncirrhotic liver: successful treatment with endovascular occlusion [post]

Carlos Senra, Pedro Marinho Lopes, Diogo Rocha, Frederico Cavalheiro, Teresa Dionisio, Marta Barbedo, Pedro Sousa
2022 unpublished
BackgroundHepatic encephalopathy in the western world is primarily associated with livercirrhosis, however it has also been reported in noncirrhotic patients with largecongenital portosystemic shunts. This case reports a successful treatment withendovascular occlusion.Case PresentationA 60-year-old male presented with a two-year history of neurologic andpsychiatric symptoms requiring multiple hospital admissions and serumhyperammonemia. Abdominal imaging was unremarkable except for the presence
more » ... of alarge vascular shunt communicating the portal vein to the left renal vein, consistent witha congenital portosystemic shunt causing hepatic encephalopathy in a noncirrhotic liver.Endovascular shunt closure was performed with Amplatzer II vascular plug with clinicalimprovement and reduction of serum ammonia to normal levels within two weeks.ConclusionAdult-onset of noncirrhotic hepatic encephalopathy is a very uncommoncondition and few reports have described endovascular treatment for these patients.Our work corroborates that the endovascular approach is a safe, minimal invasivetechnic with proven clinical benefits.
doi:10.21203/rs.3.rs-1619543/v1 fatcat:k4kosw7k3rb5po7lsj4cagmy4q