Published online Nov 6, 2021. doi: 10.12998/wjcc.v9.i31.9577
Peer-review started: March 22, 2021
First decision: May 28, 2021
Revised: May 30, 2021
Accepted: August 17, 2021
Article in press: August 17, 2021
Published online: November 6, 2021
Hepatic encephalopathy (HE) is a frequent and debilitating complication of chronic liver disease. Recurrent HE is strongly linked with spontaneous portosystemic shunts (SPSSs). Intrahepatic arterioportal fistulas (IAPFs) occur rarely but pose a major clinical challenge and may lead to or worsen portal hypertension. Herein, we present a rare case of recurrent HE secondary to a SPSS combined with an IAPF.
A 63-year-old female with primary biliary cirrhosis presented with recurrent disturbance of consciousness for 4 mo. SPSS communicating the superior mesenteric vein with the inferior vena cava and IAPF linking the intrahepatic artery with the portal vein were found on contrast-enhanced abdominal computed tomography. The patient did not respond well to medical treatment. Therefore, simultaneous embolization of SPSS and IAPF was scheduled. After embolization, the symptoms of HE showed obvious resolution.
The presence of liver vascular disorders should not be neglected in patients with chronic liver disease, and interventional therapy is a reasonable choice in such patients.
Core Tip: Hepatic encephalopathy (HE) is characterized by neurological dysfunction due to cirrhosis or portal-systemic shunting. The relationship between recurrent HE and spontaneous portosystemic shunts (SPSSs) has been demonstrated. Intrahepatic arterioportal fistulas (IAPFs), as an uncommon cause of portal hypertension, are rarely reported in HE. Herein, we present a case of recurrent HE secondary to a SPSS and IAPF. Endovascular embolization of the SPSS and IAPF was performed. Our case highlights the hemodynamic changes caused by SPSSs and IAPFs. Simultaneous embolization of an SPSS and IAPF should be considered as the optimal therapy for such patients.