Published online Jan 16, 2021. doi: 10.12998/wjcc.v9.i2.496
Peer-review started: September 24, 2020
First decision: October 27, 2020
Revised: November 8, 2020
Accepted: November 29, 2020
Article in press: November 29, 2020
Published online: January 16, 2021
Intrahepatic portosystemic venous shunt (IPSVS) is a rare hepatic disease with different clinical manifestations. Most IPSVS patients with mild shunts are asymptomatic, while the patients with severe shunts present complications such as hepatic encephalopathy. For patients with portal hypertension accompanied by intrahepatic shunt, portal hypertension may lead to hemodynamic changes that may result in exacerbated portal shunt and increased shunt flow.
A 57-year-old man, with the medical history of chronic hepatitis B and liver cirrhosis, was admitted to our hospital with abnormal behavior for 10 mo. He had received the esophageal varices ligation and entecavir therapy 1 year ago. Comparing with former examination results, the degree of esophageal varices was significantly reduced, while the right branch of the portal vein was significantly expanded and tortuous. Meanwhile, abdominal ultrasound presented the right posterior branch of portal vein connected with the retrohepatic inferior vena cava. The imaging findings indicated the diagnosis of IPSVS and hepatic encephalopathy. Instead of radiologic interventions or surgical therapies, this patient had only accepted symptomatic treatment. No recurrence of hepatic encephalopathy was observed during 1-year follow-up.
Hemodynamic changes may exacerbate intrahepatic portosystemic shunt. The intervention or surgery should be carefully applied to patients with severe portal hypertension due to the risk of hemorrhage.
Core Tip: Intrahepatic portosystemic venous shunt (IPSVS) is a rare hepatic disease. Here we have reported a case that portal hypertension exacerbated IPSVS and resulted in hepatic encephalopathy. The decreased liver stiffness and the portal hypertension expanded IPSVS and significantly increased shunt flow. Then increased shunt ratio relieved portal hypertension, but it resulted in hyperammonia and eventually precipitated hepatic encephalopathy. This case highlights hemodynamic changes may exacerbate intrahepatic portosystemic shunt. Intervention or surgery should be carefully applied to patients with severe portal hypertension due to the risk of hemorrhage.