Rationale:Esophageal variceal bleeding caused by portal hypertension is massive and life-threatening to those patients with decompensated liver cirrhosis. A transjugular intrahepatic portosystemic shunt (TIPS) can effectively stop bleeding. But the process of puncture may lead to bile duct injury and even form fistulas between the hepatic artery and bile duct.Patient concerns:The case report illustrated a 52-year-old Chinese female patient who underwent TIPS.Diagnoses:She suffered from acute upper gastrointestinal hemorrhage and acute pancreatitis because of the bile duct injury after TIPS.Interventions:The fistulas between the hepatic artery and bile duct was embolized.Outcomes:The acute upper gastrointestinal hemorrhage and acute pancreatitis of the patient were cured.Lessons:The arteriobiliary fistula should be paid more attention after TIPS while early-stage prevention should be carried out.
Background In patients with acute liver injury caused by hepatic veno-occlusive disease (HVOD), molecular adsorbent recirculation system (MARS) may be used to improve liver function in conjunction with transjugular intrahepatic portosystemic shunt (TIPS) to reduce portal hypertension. Methods Twelve patients were admitted to our hospital following treatment for HVOD for 10 to 21 days at other hospitals. All patients were treated with a combination of MARS and TIPS, and they were evaluated clinically including liver function tests. Results After the initial treatment with MARS, liver function improved significantly in all patients. TIPS placement decreased the hepatic venous pressure gradient (HVPG) to 10.17 ± 2.26 mmHg from a pre-TIPS HVPG of 23.58 ± 9.43 mmHg. The outcomes of combination treatment with MARS and TIPS in 12 patients with HVOD were as follows: 1) improvement of various clinical and biological parameters leading to full recovery in 1 year in 6 patients; 2) full recovery following liver transplantation for acute liver failure in three patients; and 3) three patients died due to hepatic failure after TIPS placement. Conclusion The combination of MARS and TIPS creation is promising as a potential treatment for acute HVOD, and it showed an improvement in overall survival.
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