title: Concomitant hepatic encephalopathy and refractory ascites: successful treatment with staged embolization of two large portosystemic shunts and transjugular intrahepatic portosystemic shunt placement.
abstract: A patient with cirrhosis, refractory ascites, and two large competitive portosystemic shunts presented with uncontrollable acute exacerbation of chronic hepatic encephalopathy (HE). A staged procedure was performed by first performing embolization of a large mesogonadal shunt to treat the HE. Three months later, a transjugular intrahepatic portosystemic shunt (TIPS) was created to address the ascites. A large paraumbilical vein shunt was embolized at TIPS placement to minimize the risk of recurrent HE. At 9-month follow-up, the ascites was well controlled with medical management with little or no HE.
authors.affiliation: Department of Radiology, Loma Linda University, 11234 Anderson St, Loma Linda, CA 92354, USA. jcsmith@llu.edu
authors.forename: Jason C
authors.initials: JC
authors.lastname: Smith
authors.forename: M Dean
authors.initials: MD
authors.lastname: Black
authors.forename: Michel H
authors.initials: MH
authors.lastname: Mendler
mesh_terms: D001201:Ascites / Q000150:complications* / Q000628:therapy*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D006499:Hepatic Artery / Q000637:transplantation*; D006501:Hepatic Encephalopathy / Q000150:complications* / Q000628:therapy*; D006801:Humans; D007601:Jugular Veins / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D016896:Treatment Outcome