A patient with portal hypertension and blindness after transjugular intrahepatic portosystemic shunt.
We report on a case of recurrent variceal bleeding from gastric varices, which was treated with transjugular intrahepatic portosystemic shunt (TIPS) and Histoacryl injection into the gastric varices. Furthermore, the patient had a small patent foramen ovale without a right-to-left shunt. After the intervention, the patient developed acute neurological disorders as a result of a cerebral paradoxical embolism. In the following, we describe the potential risk of histoacryl in paradoxical embolization when used for the injection of variceal collaterals during TIPS placement in patients with portal hypertension. The present case report shows a very rare but important complication after TIPS implantation. To avoid this complication it is recommended to perform echocardiography before all TIPS placements.
Department of Internal Medicine I, University of Bonn, Bonn, Germany. beate.appenrodt@ukb.uni-bonn.de
Beate
B
Appenrodt
M
M
Schepke
S
S
Kuntz-Hehner
A
A
Schmiedel
T
T
Sauerbruch
D000368:Aged; D001766:Blindness / Q000209:etiology*; D003287:Contrast Media / Q000009:adverse effects*; D004659:Enbucrilate / Q000009:adverse effects; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery; D006344:Heart Septal Defects, Atrial / Q000150:complications; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology* / Q000601:surgery; D020766:Intracranial Embolism / Q000209:etiology*; D007459:Iodized Oil / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000150:complications; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*
D003287:Contrast Media; D007459:Iodized Oil; D004659:Enbucrilate