title: Liver failure after an uncovered TIPS procedure associated with hepatic infarction.
abstract: Transjugular intrahepatic portosystemic shunt (TIPS) is a safe and effective procedure for the treatment of complications of liver cirrhosis, such as refractory ascites, hepatic hydrothorax and refractory variceal bleeding. The aim of this paper is to describe a rare case of liver failure after a TIPS procedure. A 38-year-old diabetic male with Child-Pugh C liver cirrhosis due to chronic hepatitis C infection who had developed refractory ascites was scheduled for a TIPS procedure. Within 24 h following TIPS placement, the patient developed distributive shock, jaundice, persistentgrade 3 hepatic encephalopathy, severe coagulopathy and acute renal failure. He was treated with lactulose enemas, broad-spectrum antibiotics and blood-derived products. Laboratory data revealed a 100-fold increase in aminotransferases and a non-enhanced computed tomography showed an irregular hypodense area in the right posterior segment of the liver. Despite being initially being in a stable condition, the patient developed progressive liver failure and died 2 mo later. Hepatic infarction is an uncommon phenomenon after a TIPS procedure; however, it can greatly complicate the course of a disease in a patient with an already compromised liver function.
authors.affiliation: Eric López-Méndez, Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubirán (INCMNSZ), Vasco de Quiroga 15, Zip Code 14000, Mexico City, Mexico.
authors.forename: Eric
authors.initials: E
authors.lastname: López-Méndez
authors.forename: Daniel
authors.initials: D
authors.lastname: Zamora-Valdés
authors.forename: Mariana
authors.initials: M
authors.lastname: Díaz-Zamudio
authors.forename: Oscar F
authors.initials: OF
authors.lastname: Fernández-Díaz
authors.forename: Lourdes
authors.initials: L
authors.lastname: Avila