Hepatic encephalopathy secondary to transtumoral portal-hepatic venous shunting.
Intrahepatic portal-systemic shunts causing hepatic encephalopathy are very rare. This is a case report of a patient with hepatic metastases of a pancreatic islet cell tumor that manifested with transtumoral shunts leading to hepatic encephalopathy. The diagnosis was confirmed with Doppler ultrasound and initially treated with selective transhepatic portal vein embolization followed by hepatic artery embolization, and eventually radiofrequency ablation of the largest metastases. Despite excellent short-term palliation, symptom recurrence necessitated liver resection, the results of which proved durable. A multidisciplinary treatment plan for the identification and management of potentially salvageable encephalopathy in similar patients is described.
Kapoor
Baljendra S
BS
Division of Interventional Radiology, Department of Surgery, University of Minnesota School of Medicine, 420 Delaware Street, Minneapolis, MN 55455, USA.
Hunter
David W
DW
Greeno
Edward
E
Pambuccian
Stefan
S
Sielaff
Timothy
T
D018273:Carcinoma, Islet Cell / Q000150:complications* / Q000556:secondary* / Q000601:surgery; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D011170:Portasystemic Shunt, Surgical / Q000009:adverse effects*