Nishi A, Kenzaka T, Sogi M, Nakaminato S, Suzuki T. Treatment of portosystemic shunt-borne hepatic encephalopathy in a 97-year-old woman using balloon-occluded retrograde transvenous obliteration: A case report. World J Clin Cases 2023; 11(4): 945-951 [PMID: 36818635 DOI: 10.12998/wjcc.v11.i4.945]
Corresponding Author of This Article
Akihiro Nishi, MD, Doctor, General Medicine, Awa Regional Medical Center, 1155 Yamamoto, Tateyama 2940014, Chiba, Japan. akihiro.nishi24@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Feb 6, 2023; 11(4): 945-951 Published online Feb 6, 2023. doi: 10.12998/wjcc.v11.i4.945
Treatment of portosystemic shunt-borne hepatic encephalopathy in a 97-year-old woman using balloon-occluded retrograde transvenous obliteration: A case report
Akihiro Nishi, Misa Sogi, General Medicine, Awa Regional Medical Center, Tateyama 2940014, Chiba, Japan
Tsuneaki Kenzaka, Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe 6500017, Hyogo, Japan
Shuichiro Nakaminato, Takahiro Suzuki, Department of Radiology, Kameda Medical Center, Kamogawa 2968602, Chiba, Japan
Author contributions: Nishi A managed the case and wrote and revised the manuscript; Kenzaka T, Sogi M, Nakaminato S, and Suzuki T assisted with the preparation and revision of the manuscript; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Akihiro Nishi, MD, Doctor, General Medicine, Awa Regional Medical Center, 1155 Yamamoto, Tateyama 2940014, Chiba, Japan. akihiro.nishi24@gmail.com
Received: October 17, 2022 Peer-review started: October 17, 2022 First decision: December 26, 2022 Revised: December 30, 2022 Accepted: January 12, 2023 Article in press: January 12, 2023 Published online: February 6, 2023 Processing time: 111 Days and 18.4 Hours
Abstract
BACKGROUND
Hyperammonemia and hepatic encephalopathy are common in patients with portosystemic shunts. Surgical shunt occlusion has been standard treatment, although recently the less invasive balloon-occluded retrograde transvenous obliteration (B-RTO) has gained increasing attention. Thus far, there have been no reports on the treatment of portosystemic shunts with B-RTO in patients aged over 90 years. In this study, we present a case of hepatic encephalopathy caused by shunting of the left common iliac and inferior mesenteric veins, successfully treated with B-RTO.
CASE SUMMARY
A 97-year-old woman with no history of liver disease was admitted to our hospital because of disturbance of consciousness. She had no jaundice, spider angioma, palmar erythema, hepatosplenomegaly, or asterixis. Her blood tests showed hyperammonemia, and abdominal contrast-enhanced computed tomography revealed a portosystemic shunt running between the left common iliac vein and the inferior mesenteric vein. She was diagnosed with hepatic encephalopathy secondary to a portosystemic shunt. The patient did not improve with conservative treatment: Lactulose, rifaximin, and a low-protein diet. B-RTO was performed, which resulted in shunt closure and improvement in hyperammonemia and disturbance of consciousness. Moreover, there was no abdominal pain or elevated levels of liver enzymes due to complications. The patient was discharged without further consciousness disturbance.
CONCLUSION
Portosystemic shunt-borne hepatic encephalopathy must be considered in the differential diagnosis for consciousness disturbance, including abnormal behavior and speech.
Core Tip: Hyperammonemia and hepatic encephalopathy are common with portosystemic shunts. In this case, hepatic encephalopathy caused by shunting of the left common iliac and inferior mesenteric veins was successfully treated with balloon-occluded retrograde transvenous obliteration (B-RTO). A 97-year-old woman was diagnosed with hepatic encephalopathy secondary to a portosystemic shunt. The patient did not improve with conservative treatment: Lactulose, rifaximin, and a low-protein diet. B-RTO was performed, resulting in shunt closure and improvement in hyperammonemia and disturbance of consciousness. The patient was discharged without further consciousness disturbance.Portosystemic shunt-borne hepatic encephalopathy must be considered in the differential diagnosis for consciousness disturbance, including abnormal behavior and speech.
