López-Méndez E, Zamora-Valdés D, Díaz-Zamudio M, Fernández-Díaz OF, Ávila L. Liver failure after an uncovered TIPS procedure associated with hepatic infarction. World J Hepatol 2010; 2(4): 167-170 [PMID: 21160990 DOI: 10.4254/wjh.v2.i4.167]
Corresponding Author of This Article
Eric López-Méndez, MD, Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubirán (INCMNSZ), Vasco de Quiroga 15, Section XVI, Tlalpan, Zip Code 14000, Mexico City, Mexico. ericlopezmendez@yahoo.com.mx
Article-Type of This Article
Case Report
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World J Hepatol. Apr 27, 2010; 2(4): 167-170 Published online Apr 27, 2010. doi: 10.4254/wjh.v2.i4.167
Liver failure after an uncovered TIPS procedure associated with hepatic infarction
Eric López-Méndez, Daniel Zamora-Valdés, Mariana Díaz-Zamudio, Oscar F Fernández-Díaz, Lourdes Ávila
Eric López-Méndez, Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubirán (INCMNSZ), Vasco de Quiroga 15, Zip Code 14000, Mexico City, Mexico
Oscar F Fernández-Díaz, Daniel Zamora-Valdés, Department of Surgery, INCMNSZ, Vasco de Quiroga 15, Zip Code 14000, Mexico City, Mexico
Mariana Díaz-Zamudio, Lourdes Ávila, Department of Radiology and Imaging, INCMNSZ, Vasco de Quiroga 15, Zip Code 14000, Mexico City, Mexico
Author contributions: López-Méndez E placed the TIPS; López-Méndez E, Zamora-Valdés D and Fernández-Díaz OF provided post-TIPS medical care and wrote the paper; Diaz-Zamudio M and Ávila L performed and analyzed ultrasound and computed tomography imaging; López-Méndez E, Zamora-Valdés D, Díaz-Zamudio M, Fernández-Díaz OF and Ávila L revised the draft content; and Fernández-Díaz OF revised the manuscript’s English.
Correspondence to: Eric López-Méndez, MD, Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubirán (INCMNSZ), Vasco de Quiroga 15, Section XVI, Tlalpan, Zip Code 14000, Mexico City, Mexico. ericlopezmendez@yahoo.com.mx
Telephone: +52-55-733418 Fax: +52-55-733418
Received: July 27, 2009 Revised: March 28, 2010 Accepted: April 4, 2010 Published online: April 27, 2010
Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) is a safe and effective procedure for the treatment of complications of liver cirrhosis, such as refractory ascites, hepatic hydrothorax and refractory variceal bleeding. The aim of this paper is to describe a rare case of liver failure after a TIPS procedure. A 38-year-old diabetic male with Child-Pugh C liver cirrhosis due to chronic hepatitis C infection who had developed refractory ascites was scheduled for a TIPS procedure. Within 24 h following TIPS placement, the patient developed distributive shock, jaundice, persistentgrade 3 hepatic encephalopathy, severe coagulopathy and acute renal failure. He was treated with lactulose enemas, broad-spectrum antibiotics and blood-derived products. Laboratory data revealed a 100-fold increase in aminotransferases and a non-enhanced computed tomography showed an irregular hypodense area in the right posterior segment of the liver. Despite being initially being in a stable condition, the patient developed progressive liver failure and died 2 mo later. Hepatic infarction is an uncommon phenomenon after a TIPS procedure; however, it can greatly complicate the course of a disease in a patient with an already compromised liver function.
