[Transjugular intrahepatic portosystemic shunt before hepatic surgery in a patient with cirrhosis and portal hypertension: case report].
Major abdominal surgery may be contraindicated in patients with cirrhosis because of the high risk of intraoperative bleeding and postoperative decompensation. Careful preparation of these patients is essential, aimed especially at reducing portal hypertension. We report the case of a patient with cirrhosis complicated by hepatocellular carcinoma, whose portal hypertension manifested almost exclusively by reanastomosis from the umbilical vein. A transjugular intrahepatic portosystemic shunt (TIPS) was placed before surgery to prepare the patient for hepatic resection. In addition to the singularity of the presentation of portal hypertension, this case prompts us to consider neoadjuvant TIPS as a means of preparing these at-risk patients for major abdominal surgery.
Chalret Du Rieu
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M
Service de chirurgie générale et digestive, hôpital Purpan, CHU de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex, France.
Carrere
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N
Bureau
C
C
Lagarde
S
S
Otal
P
P
Pradere
B
B
D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical; D011300:Preoperative Care