Successful Treatment for Hepatic Encephalopathy Aggravated by Portal Vein Thrombosis with Balloon-Occluded Retrograde Transvenous Obliteration

Hashimoto, Noriyuki; Akahoshi, Tomohiko; Shoji, Tetsuya; Tomikawa, Morimasa; Tsutsumi, Norifumi; Yoshizumi, Tomoharu; Taketomi, Akinobu; Shirabe, Ken; Maehara, Yoshihiko

doi:10.1159/000330287

Cited by 3 publications

(1 citation statement)

References 16 publications

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“…There are only a few reports of combined therapy using surgery and RTO for HCC with PSS [ 12 , 13 ]. RTO such as TJO [ 14 ] or balloon-occluded transvenous obliteration (B-RTO) [ 15 ] is popular in Japan for gastric variceal treatment.…”

Section: Discussionmentioning

confidence: 99%

Transjugular Retrograde Obliteration prior to Liver Resection for Hepatocellular Carcinoma Associated with Hyperammonemia due to Spontaneous Portosystemic Shunt

Chikamori

Kuniyoshi

2013

Case Reports in Hepatology

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A 67-year-old woman had hepatocellular carcinoma (HCC) measuring 3.7 cm at S8 of the liver with hyperammonemia due to a spontaneous giant mesocaval shunt. Admission laboratory data revealed albumin, 2.9 g/dL; total bilirubin, 1.3 mg/dL; plasma ammonia level (NH3), 152 g/dL; total bile acid (TBA) 108.5 μmoL/L; indocyanine green retention rate at 15 min (ICG15), 63%. Superior mesenteric arterial portography revealed a hepatofugal giant mesocaval shunt, and the portal vein was not visualized. Before surgery, transjugular retrograde obliteration (TJO) for the mesocaval shunt was attempted to normalize the portal blood flow. Via the right internal jugular vein, a 6 F occlusive balloon catheter was inserted superselectively into the mesocaval shunt. The mesocaval shunt was successfully embolized using absolute ethanol and a 50% glucose solution. Eleven days after TJO, NH3, TBA, and ICG15 decreased to 56, 44, and 33, respectively. Superior mesenteric arterial portography after TJO revealed a hepatopetal portal flow. Partial hepatectomy of S8 was performed 25 days after TJO. The subsequent clinical course showed no complications, and the woman was discharged on postoperative day 14. We conclude that the combined therapy of surgery and TJO is an effective means of treating HCC with hyperammonemia due to a spontaneous portosystemic shunt.

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Section: Discussionmentioning

confidence: 99%

Transjugular Retrograde Obliteration prior to Liver Resection for Hepatocellular Carcinoma Associated with Hyperammonemia due to Spontaneous Portosystemic Shunt

Chikamori

Kuniyoshi

2013

Case Reports in Hepatology

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Efficacy of Balloon-occluded Retrograde Transvenous Obliteration of Large Spontaneous Lienorenal Shunt in Patients with Severe Recurrent Hepatic Encephalopathy with Foam Sclerotherapy: Initial Experience

Mukund¹,

Rajesh²,

Arora³

et al. 2012

Journal of Vascular and Interventional Radiology

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Caution for living donor liver transplantation with congenital portosystemic shunt: a case report

et al. 2022

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Background Congenital portosystemic shunt is an infrequent abnormal connection between the portal vascular system and the systemic circulation. Portosystemic shunts are common findings in patients with cirrhosis, causing gastroesophageal varices, hepatic encephalopathy, and others. However, there is no consensus or literature describing how to manage asymptomatic patients with portosystemic shunts and normal liver. Case presentation The patient was a 39-year-old female who underwent donor right hepatectomy for living donor liver transplantation. The patient was healthy by nature, however, developed hepatic encephalopathy after the surgery due to a development of portosystemic shunt. Portosystemic shunt stole portal blood flow, and imaging modalities revealed narrowing of the portal trunk, representing prolonged depletion of portal blood flow. Balloon-occluded retrograde transvenous obliteration (B-RTO) was performed for occlusion of the portosystemic shunt. B-RTO increased portal blood flow, and hepatic encephalopathy with hyperammonemia was successfully resolved without the outbreak of any other symptom of portal hypertension. Conclusions A congenital portosystemic shunt itself is not a contraindication for donor hepatectomy, but perioperative endovascular shunts occlusion or intraoperative ligature of these shunts should be considered.

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Successful Treatment for Hepatic Encephalopathy Aggravated by Portal Vein Thrombosis with Balloon-Occluded Retrograde Transvenous Obliteration

Cited by 3 publications

References 16 publications

Transjugular Retrograde Obliteration prior to Liver Resection for Hepatocellular Carcinoma Associated with Hyperammonemia due to Spontaneous Portosystemic Shunt

Transjugular Retrograde Obliteration prior to Liver Resection for Hepatocellular Carcinoma Associated with Hyperammonemia due to Spontaneous Portosystemic Shunt

Efficacy of Balloon-occluded Retrograde Transvenous Obliteration of Large Spontaneous Lienorenal Shunt in Patients with Severe Recurrent Hepatic Encephalopathy with Foam Sclerotherapy: Initial Experience

Caution for living donor liver transplantation with congenital portosystemic shunt: a case report

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