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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 9/2016

01-09-2016 | GI Image

Non-lethal Right Liver Atrophy After TIPS Occlusion in A Cirrhotic Patient: Introducing The Hepatic Biembolization

Authors: Bertrand Le Roy, Johan Gagnière, Pascal Chabrot, Denis Pezet, Armand Abergel, Emmanuel Buc

Published in: Journal of Gastrointestinal Surgery | Issue 9/2016

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Abstract

Background

Transjugular intrahepatic portosystemic shunt (TIPS) is the standard procedure in the treatment of refractory ascites and variceal bleeding in the setting of portal hypertension. Secondary obstruction of the shunt is a classic but potentially lethal complication.

Methods

We present here the case of a cirrhotic patient that underwent a TIPS for refractory ascites, with early complete thrombosis without lethal complication.

Results

Obstruction of the TIPS led to thrombosis of both the right hepatic and the right portal veins with progressive total atrophy of the right liver and marked hypertrophy of the left liver. Despite initial poor liver function, biological hepatic markers improved slowly until complete recovery.

Conclusion

Hence, we suggest the concept of combined right portal and hepatic vein embolization as a new procedure to induce partial liver hypertrophy before major liver resection, even in cirrhotic patients.
Literature
1.
Salerno F, Camma C, Enea M, Rossle M, Wong F. Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. Gastroenterology 2007;133(3):825-34.CrossRefPubMed
2.
Denys A, Lacombe C, Schneider F, Madoff DC, Doenz F, Qanadli SD, et al. Portal vein embolization with N-butyl cyanoacrylate before partial hepatectomy in patients with hepatocellular carcinoma and underlying cirrhosis or advanced fibrosis. J Vasc Interv Radiol 2005;16:1667-1674.CrossRefPubMed
3.
Hwang S, Lee SG, Ko GY, Kim BS, Sung KB, Kim MH, et al. Sequential preoperative ipsilateral hepatic vein embolization after portal vein embolization to induce further liver regeneration in patients with hepatobiliary malignancy. Ann Surg 2009;249:608-616.CrossRefPubMed
Metadata
Title
Non-lethal Right Liver Atrophy After TIPS Occlusion in A Cirrhotic Patient: Introducing The Hepatic Biembolization
Authors
Bertrand Le Roy
Johan Gagnière
Pascal Chabrot
Denis Pezet
Armand Abergel
Emmanuel Buc
Publication date
01-09-2016
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 9/2016
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-016-3133-z

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