Placement of transjugular intrahepatic portosystemic shunt via the left hepatic vein under sonographic guidance in a patient with right hemihepatectomy.

In a patient with refractory ascites after right hemihepatectomy TIPS was created between the left hepatic vein and the left portal vein via a transjugular approach. The puncture was guided only by sonography from the epigastrium. Portosystemic pressure gradient was reduced from 28 to 7 mm Hg and ascites disappeared. This case shows that TIPS can be created with technical and clinical success after right hemihepatectomy as left hepatic vein to left portal vein shunt under sonographic guidance.