Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2021; 9(31): 9577-9583
Published online Nov 6, 2021. doi: 10.12998/wjcc.v9.i31.9577
Simultaneous embolization of a spontaneous porto-systemic shunt and intrahepatic arterioportal fistula: A case report
Guo-Feng Liu, Xiao-Ze Wang, Xue-Feng Luo
Guo-Feng Liu, Xiao-Ze Wang, Xue-Feng Luo, Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Liu GF contributed to analysis and interpretation of the data and drafting of the article; Wang XZ contributed to material support; Luo XF performed the procedure and revised the paper.
Supported by 1·3·5 Project for Disciplines of Excellence–Clinical Research Incubation Project, West China Hospital, Sichuan University, No. 2019HXFH055; and Project for Science & Technology Department of Sichuan Province, No. 2020YFH0089.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: All authors declare no conflicts of interest.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xue-Feng Luo, MD, Associate Professor, Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu 610041, Sichuan Province, China. luo_xuefeng@wchscu.cn
Received: March 22, 2021
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

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.

Keywords: Spontaneous portosystemic shunts, Intrahepatic arterioportal fistula, Endovascular embolization, Hepatic encephalopathy, Liver disease, Case report

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.