Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2019; 7(17): 2573-2579
Published online Sep 6, 2019. doi: 10.12998/wjcc.v7.i17.2573
Rare spontaneous intrahepatic portosystemic shunt in hepatitis B-induced cirrhosis: A case report
You-Wen Tan, Jian-Hui Sheng, Hui-Ying Tan, Li Sun, Yu-Mei Yin
You-Wen Tan, Jian-Hui Sheng, Hui-Ying Tan, Li Sun, Yu-Mei Yin, Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang 212003, Jiangsu Province, China
Author contributions: Tan YW, Sheng JH and Tan HY contributed equally to this work. Tan YW and Sheng JH designed the research; Tan HY, Sun L and Yin YM collected and analyzed the data, and drafted the manuscript; Tan YW and Tan HY wrote and revised the manuscript; all authors have read and approved the final version to be published.
Informed consent statement: Informed consent was obtained from the parent.
Conflict-of-interest statement: The authors declare no conflict of interest.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE 2016 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: You-Wen Tan, MD, PhD, Chief Doctor, Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, No. 300, Daijiamen, Runzhou Distinct, Zhenjiang 212003, Jiangsu Province, China. tyw915@sina.com
Telephone: +86-511-88970796Fax: +86-511-88970796
Received: March 15, 2019
Peer-review started: March 15, 2019
First decision: July 30, 2019
Revised: August 1, 2019
Accepted: August 20, 2019
Article in press: August 20, 2019
Published online: September 6, 2019
Abstract
BACKGROUND

The portosystemic shunt is the pathway between the portal vein (PV) and systemic circulation. A spontaneous intrahepatic portosystemic shunt (SPISS) is a rare portosystemic shunt type. Here we report an extremely rare type of SPISS, a spontaneous intrahepatic PV-inferior vena cava shunt (SPIVCS).

CASE SUMMARY

A 66-year-old woman was admitted to our hospital with the complaint of abdominal distention and a decreased appetite for 1 mo. The patient had a 20-year history of hepatitis B surface antigen positivity and a 5-year history of cirrhosis. She had been treated with Chinese herbal medicine for a long time. Liver function tests showed: alanine aminotransferase, 35 U/L; aspartate aminotransferase, 42 U/L; serum albumin (ALB) 32.2 g/L; and serum ascites ALB gradient, 25.2 g/L. Abdominal ultrasonography and enhanced computed tomography showed that the left branch of the PV was thin and occluded; the right branch of the PV was thick and showed a vermicular dilatation vein cluster in the upper pole of the right kidney that branched out and converged into the inferior vena cava from the bare area of the lower right posterior lobe of the liver. We diagnosed her with an extremely rare SPIVCS caused by portal hypertension and provided symptomatic treatment after admission. One week later, her symptoms disappeared and she was discharged.

CONCLUSION

SPIVCS is a rare portosystemic shunt with a clear history of cirrhosis and portal hypertension. Clarifying the type PV shunt has important clinical significance.

Keywords: Spontaneous, Intrahepatic, Portosystemic shunt, Cirrhosis, Case report

Core tip: Here we report a spontaneous intrahepatic portal vein (PV)-inferior vena cava shunt. A 66-year-old woman was admitted to our hospital with a 20-year history of HBsAg and a 5-year history of cirrhosis. Abdominal ultrasonography and enhanced computed tomography showed that the left branch of the PV was thin and occluded; the right branch of the PV was thick and showed a vermicular dilatation vein cluster in the upper pole of the right kidney that branched out and converged into the inferior vena cava from the bare area of the lower right posterior lobe of the liver.