Maruyama, H., Kobayashi, K., Kiyono, S., Ogasawara, S., Ooka, Y., Suzuki, E., et al. (2019) Incidence and Hemodynamic Feature of Risky Esophageal Varices with Lower Hepatic Venous Pressure Gradient. International Journal of Medical Sciences, 16, 1614-1620.
https://doi.org/10.7150/ijms.37040

has been cited by the following article:

• TITLE: Early Hepatic Encephalopathy after a Transjugular Intrahepatic Portosystemic Shunt Procedure: Case Report

  AUTHORS: Miriam Viviane Baron, Gabriela Di Lorenzo Garcia Scherer, Michele Paula dos Santos, Andres Felipe Mantilla Santamaria, Cristine Brandenburg, Isabel Cristina Reinheimer, Marcus Vinicius de Mello Pinto, Aline Ronis Sampaio, Alexandre Gomes Sancho, Alexandre Gomes Sancho, Esteban Fortuny Pacheco, Felice Picariello, Danielle de Mello Florentino, Joice Nedel Ott, Carolina Gonçalves Pinheiro, Nathália Ken Pereira Iketani, Sonia Carvalho, Patrícia Froes Meyer, Bartira Ercília Pinheiro da Costa

  KEYWORDS: Ascites, Hypernatremia, Portasystemic Shunt Transjugular Intrahepatic, Hepatic Encephalopathy

  JOURNAL NAME: Open Journal of Gastroenterology, Vol.11 No.6, June 29, 2021

  ABSTRACT: Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications arising from cirrhosis. The aim of this paper is to report a case of a patient with liver cirrhosis and the complications of a transjugular intrahepatic portosystemic shunt. Male, elderly, and ex-alcoholic, diagnosed with liver cirrhosis, ascites, and esophageal varices. He underwent transjugular intrahepatic portosystemic shunt due to portal hypertension and returned to the hospital after 24 hours with agitation and mental confusion. He had a bowel movement stop, neurological worsening, loss of renal function, hepatic hydrothorax, hepatic encephalopathy, hypernatremia, hypocalcemia, and hypophosphatemia. He underwent a new procedure to occlude the transjugular intrahepatic portosystemic shunt, showing improvement of the mental status and ascites. However, continued with decompensation and hydro-electrolytic disorders. He evolved with worsening of the ventilatory pattern, and neurological and renal function, with a fatal outcome. Esophageal varices due to portal hypertension can be corrected with the transjugular intrahepatic portosystemic shunt. However, complications such as hypernatremia, hepatic hydrothorax, and hepatic encephalopathy may occur. Therefore, there is a need for reintervention to shunt or reduce its caliber. Thus, for patients with advanced age and decompensated cirrhosis, the potential risks and benefits of this procedure should be carefully evaluated due to the risk of complications and death.