Hepatic encephalopathy secondary to a splenorenal shunt that manifested a long time after a liver transplantation

A Challenging Case of Refractory Hepatic Encephalopathy in a Postliver Retransplant Patient with Thrombosed Portal Vein: A Shunt for a Shunt

Hepatic encephalopathy (HE) is a frequent and serious complication of chronic liver disease. The mechanism of hepatic encephalopathy is not entirely clear. Hepatic encephalopathy is defined as brain dysfunction caused by liver insufficiency and/or portal-systemic blood shunting. It manifests as a wide spectrum of neurological or psychiatric abnormalities, ranging from subclinical alterations, detectable only by neuropsychological or neurophysiological assessment, to coma. Liver transplant (LT) is the definitive treatment for refractory hepatic encephalopathy. In this case, we present a challenging case of refractory hepatic encephalopathy in a postliver transplant patient with portal vein thrombosis and a splenorenal shunt treated with a novel technique to address his complex anatomy.

Percutaneous treatment of a splenorenal shunt with an atrial septal closure device

We present the case of a 70-year-old female who underwent liver transplantation in 2011 due to enolic cirrhosis with a normofunction graft and no portal hypertension. During the last months, recurrent hospitalization was needed due to hepatic encephalopathy, in spite of treatment with lactulose and rifaximin. An abdominal computed tomography (CT) showed a large varicose dilatation of the splenic vein up to 14-16 mm, descending by the left abdominal side, communicating with the renal vein with direct drainage into inferior cava vein (ICV).