Early Hepatic Encephalopathy after a Transjugular Intrahepatic Portosystemic Shunt Procedure: Case Report
- 1 Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS), Porto Alegre, Rio Grande do Sul, Brazil
- 2 School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS), Porto Alegre, Rio Grande do Sul, Brazil
- 3 School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS), Porto Alegre, Rio Grande do Sul, Brazil
- 4 Industrial University of Santander (UIS), Bucaramanga, Colombia
- 5 University of Vale do Acaraú (IDJ/UVA), Ceará, Brazil
- 6 Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS), Porto Alegre, Rio Grande do Sul, Brazil
- 7 Celulare Institute, Rio de Janeiro, Brazil
- 8 Celulare Institute, Rio de Janeiro, Brazil
- 9 Unigranrio, Rio de Janeiro, Brazil
- 10 Unigranrio, Rio de Janeiro, Brazil
- 11 Universidad Finis Terrae, Santiago, Chile
- 12 Università degli Studi di Napoli Federico II, Napoli, Italy
- 13 Uniredentor University, Rio de Janeiro, Brazil
- 14 Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS), Porto Alegre, Rio Grande do Sul, Brazil
- 15 Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC (FABC), São Paulo, Brazil
- 16 Hospital Beneficiente Portuguesa of Belém, Pará, Brazil
- 17 Rigshospital, Copenhagen East, København, Denmark
- 18 Centro Universitário do Rio Grande do Norte, Natal, Brazil
- 19 Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS), Porto Alegre, Rio Grande do Sul, Brazil
Abstract
Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications arising from cirrhosis. The aim of this paper is to report a case of a patient with liver cirrhosis and the complications of a transjugular intrahepatic portosystemic shunt. Male, elderly, and ex-alcoholic, diagnosed with liver cirrho sis, ascites, and esophageal varices. He underwent transjugular intrahepatic portosystemic shunt due to portal hypertension and returned to the hospital after 24 hours with agitation and mental confusion. He had a bowel move ment stop, neurological worsening, loss of renal function, hepatic hydrothorax, hepatic encephalopathy, hypernatremia, hypocalcemia, and hypophosphatemia. He underwent a new procedure to occlude the transjugular intrahepatic portosystemic shunt, showing improvement of the mental status and ascites. However, continued with decompensation and hydro-electrolytic disorders. He evolved with worsening of the ventilatory pattern, and neurological and renal function, with a fatal outcome. Esophageal varices due to portal hypertension can be corrected with the transjugular intrahepatic portosystemic shunt. However, complications such as hypernatremia, hepatic hydrothorax, and hepatic encephalopathy may occur. Therefore, there is a need for reintervention to shunt or reduce its caliber. Thus, for patients with advanced age and decompensated cirrhosis, the potential risks and benefits of this procedure should be carefully evaluated due to the risk of complications and death.
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