Transjugular intrahepatic portosystemic shunt in an infant

Abstract

A 15-month-old girl, who presented with biliary cirrhosis secondary to cystic fibrosis with refractory ascites and recurrent intestinal bleeding, underwent percutaneous transjugular intrahepatic portosystemic shunting. Immediately following the procedure the ascites disappeared and no further bleeding occurred. The stent shunt was patent on Doppler ultrasound until the 22nd day. The patient died on day 22 because of liver failure due to a low-flow syndrome with severe hepatic ischaemia, but with no recurrence of bleeding or ascites.

Acute variceal bleeding: general management

“…These sites are also amenable to embolization via shunt. TIPS have been successfully placed in infants [104,105] , and children [106][107][108] with similar efficacy.…”

Successful treatment of refractory ascites in a child with transjugular intrahepatic portosystemic shunt

“…To date, there has been increasing use of TIPS in the management of ascites in adults (2,3). There have been some reports on the use of TIPS in the management of refractory ascites in children, but the results have not been universally successful (3)(4)(5)(6). This case describes the use of TIPS as a management option in a child with refractory ascites secondary to liver cirrhosis.…”

Portosystemic shunt as a bridge to liver transplantation in infants: A comparison of two techniques

“…A few previous case reports have reported successful creation of TIPS in infants, but as demonstrated in the first case presented in this paper, TIPS creation in this population can often be technically challenging. This is due to the small size of the peripheral intrahepatic vessels in infants and possible unfavorable anatomic relationships between the portal and hepatic veins.…”

“…DIPS has not been shown to cause worse encephalopathy or have greater incidence of this complication compared to TIPS. [9][10][11][12] Both patients in our case series developed signs of hepatic encephalopathy, including hyperammonemia and agitation, and both were managed with aggressive medical treatment until they received a liver transplant.…”