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.