title: Combination therapy using PSE and TIO ameliorates hepatic encephalopathy due to intrahepatic portosystemic venous shunt in idiopathic portal hypertension.
abstract: A 64-year-old woman treated for anemia and ascites exhibited hepatic encephalopathy. Abdominal ultrasonography and computed tomography (CT) showed communication between the portal vein and the middle hepatic vein, indicating an intrahepatic portosystemic venous shunt (PSS). Since hepatic encephalopathy of the patient was resistant to medical treatment, interventional radiology was performed for the treatment of shunt obliteration. Hepatic venography showed anastomosis between the hepatic vein branches, supporting the diagnosis of idiopathic portal hypertension (IPH). To minimize the increase in portal vein pressure after shunt obliteration, partial splenic artery embolization (PSE) was first performed to reduce portal vein blood flow. Transileocolic venous obliteration (TIO) was then performed, and intrahepatic PSS was successfully obliterated using coils with n-butyl-2-cyanoacrylate (NBCA). In the present case, hepatic encephalopathy due to intrahepatic PSS in the patient with IPH was successfully treated by combination therapy using PSE and TIO.
authors.affiliation: Division of Gastroenterology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Kojima
authors.affiliation: Division of Gastroenterology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ito
authors.affiliation: Division of Gastroenterology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Takashimizu
authors.affiliation: Division of Gastroenterology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ichikawa
authors.affiliation: Division of Radiology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Division of Radiology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Terumitsu
authors.initials: T
authors.lastname: Hasebe
authors.affiliation: Division of Gastroenterology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Norihito
authors.initials: N
authors.lastname: Watanabe
keywords: Intrahepatic portosystemic venous shunt (PSS); hepatic encephalopathy; idiopathic portal hypertension (IPH); partial splenic artery embolization (PSE); transileocolic venous obliteration (TIO)