BACKGROUND: Congenital portosystemic shunt is an infrequent abnormal connection between the portal vascular system and the systemic circulation. Portosystemic shunts are common findings in patients with cirrhosis, causing gastroesophageal varices, hepatic encephalopathy, and others. However, there is no consensus or literature describing how to manage asymptomatic patients with portosystemic shunts and normal liver. CASE PRESENTATION: The patient was a 39-year-old female who underwent donor right hepatectomy for living donor liver transplantation. The patient was healthy by nature, however, developed hepatic encephalopathy after the surgery due to a development of portosystemic shunt. Portosystemic shunt stole portal blood flow, and imaging modalities revealed narrowing of the portal trunk, representing prolonged depletion of portal blood flow. Balloon-occluded retrograde transvenous obliteration (B-RTO) was performed for occlusion of the portosystemic shunt. B-RTO increased portal blood flow, and hepatic encephalopathy with hyperammonemia was successfully resolved without the outbreak of any other symptom of portal hypertension. CONCLUSIONS: A congenital portosystemic shunt itself is not a contraindication for donor hepatectomy, but perioperative endovascular shunts occlusion or intraoperative ligature of these shunts should be considered.
BACKGROUND: Congenital portosystemic shunt is an infrequent abnormal connection between the portal vascular system and the systemic circulation. Portosystemic shunts are common findings in patients with cirrhosis, causing gastroesophageal varices, hepatic encephalopathy, and others. However, there is no consensus or literature describing how to manage asymptomatic patients with portosystemic shunts and normal liver. CASE PRESENTATION: The patient was a 39-year-old female who underwent donor right hepatectomy for living donor liver transplantation. The patient was healthy by nature, however, developed hepatic encephalopathy after the surgery due to a development of portosystemic shunt. Portosystemic shunt stole portal blood flow, and imaging modalities revealed narrowing of the portal trunk, representing prolonged depletion of portal blood flow. Balloon-occluded retrograde transvenous obliteration (B-RTO) was performed for occlusion of the portosystemic shunt. B-RTO increased portal blood flow, and hepatic encephalopathy with hyperammonemia was successfully resolved without the outbreak of any other symptom of portal hypertension. CONCLUSIONS: A congenital portosystemic shunt itself is not a contraindication for donor hepatectomy, but perioperative endovascular shunts occlusion or intraoperative ligature of these shunts should be considered.
Authors: Anna Baiges; Fanny Turon; Macarena Simón-Talero; Stephanie Tasayco; Javier Bueno; Kamal Zekrini; Aurélie Plessier; Stéphanie Franchi-Abella; Florent Guerin; Amar Mukund; C E Eapen; Ashish Goel; Nidugala Keshava Shyamkumar; Sandra Coenen; Andrea De Gottardi; Avik Majumdar; Simona Onali; Akash Shukla; Flair José Carrilho; Lucas Nacif; Massimo Primignani; Giulia Tosetti; Vicenzo La Mura; Frederik Nevens; Peter Witters; Dhiraj Tripathi; Luis Tellez; Javier Martínez; Carmen Álvarez-Navascués; Miguel López Fraile López; Bogdan Procopet; Fabio Piscaglia; Barbara de Koning; Elba Llop; Mario Romero-Cristobal; Eric Tjwa; Alberto Monescillo-Francia; Marco Senzolo; Mercedes Perez-LaFuente; Antonio Segarra; Shiv Kumar Sarin; Virginia Hernández-Gea; David Patch; Wim Laleman; Hermien Hartog; Dominique Valla; Joan Genescà; Juan Carlos García-Pagán Journal: Hepatology Date: 2019-08-19 Impact factor: 17.425