The use of transjugular intrahepatic portosystemic shunt and surgical portocaval H-shunt for the treatment of colorectal variceal bleeding.

Surgical portocaval H-shunt was performed after the thrombosis of a transjugular intrahepatic portosystemic shunt inserted for colorectal variceal bleeding. The surgical procedure successfully controlled the variceal bleeding. However, the patient developed postoperative liver failure and hepatic encephalopathy due to complete portal vein thrombosis and the absence of prograde portal flow. This case illustrates the potential risks of the serial use of transjugular intrahepatic portosystemic shunt and surgical portocaval shunt leading to complete portal vein thrombosis, hepatic encephalopathy and acute liver failure.