scholarly journals Potential Pitfalls in Transjugular Portosystemic Shunt Placement for Bleeding Rectal Varices

2015 ◽  
Vol 9 (2) ◽  
pp. 296-301 ◽  
Author(s):  
S M Nazmus Sakib ◽  
Katsuhiro Kobayashi ◽  
Mohammed Jawed
Keyword(s):  
Portal Hypertension ◽  
Endoscopic Therapy ◽  
Alcoholic Cirrhosis ◽  
Massive Bleeding ◽  
Portosystemic Shunt ◽  
Early Mortality ◽  
Rectal Varices ◽  
Life Threatening ◽  
Intrahepatic Portosystemic Shunt ◽  
Transjugular Portosystemic Shunt

In patients with portal hypertension, bleeding from rectal varices is rare. However, it can be life-threatening. We report a case of massive bleeding from large rectal varices in a 59-year-old man with alcoholic cirrhosis. Emergent transjugular intrahepatic portosystemic shunt (TIPS) placement was performed following failed local endoscopic therapy. Despite normalization of the portosystemic pressure gradient, the patient had another episode of massive bleeding on the following day. Embolization of the rectal varices via TIPS successfully stopped the bleeding. After the procedure, rapid decompensation of the cirrhosis led to severe encephalopathy, and death was observed. Although TIPSs have been reported to be useful in controlling bleeding from rectal varices, our case illustrates the potential pitfalls in using this technique in the treatment of rectal variceal bleeding. TIPSs may not be always successful in controlling massive bleeding from large rectal varices, even after normalization of portal hypertension. TIPSs can also be associated with life-threatening complications that may lead to early mortality.

scholarly journals Halting the haematochezia

2020 ◽  
pp. flgastro-2020-101495
Author(s):  
Meera Mistry ◽  
Joseph Fiske ◽  
Tehreem Chaudhry ◽  
Timothy J Cross ◽  
Shemin Mehta ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Sclerosing Cholangitis ◽  
Flexible Sigmoidoscopy ◽  
Endoscopic Therapy ◽  
Balloon Occlusion ◽  
Portosystemic Shunt ◽  
Good Effect ◽  
Rectal Varices ◽  
Risk Of Rupture ◽  
Intrahepatic Portosystemic Shunt

An elderly gentleman with primary sclerosing cholangitis (PSC) was admitted with rectal bleeding, shown on flexible sigmoidoscopy to be arising from rectal varices, which bled despite endoscopic therapy with histoacryl glue. Therapeutic options were limited with surgery and transjugular intrahepatic portosystemic shunt deemed too high risk, and endovascular embolisation through interventional radiology was sought. Coil-assisted retrograde transvenous obliteration was used to good effect. This rare approach has advantages over balloon occlusion, avoiding long indwelling balloon time and risk of rupture or infection, as well as time efficiency.

scholarly journals Bleeding due to ectopic varices in a urinary diversion: A multidisciplinary diagnostic and therapeutic challenge

2015 ◽  
Vol 9 (11-12) ◽  
pp. 897
Author(s):  
Eduardo Mariano Albers Acosta ◽  
Alfonsi Friera Reyes ◽  
Ricardo Brime Menéndez
Keyword(s):  
Portal Hypertension ◽  
Urinary Diversion ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Recurrent Bleeding ◽  
Gi Tract ◽  
Ectopic Varices ◽  
Life Threatening ◽  
Intrahepatic Portosystemic Shunt ◽  
Urological Emergency

The ectopic varices in patients with portal hypertension are those that occur at any level of the gastrointestinal (GI) tract, regardless of the varices that occur at the esophageal level. These ectopic varices account for 2‒5% of the causes of GI bleeding varices. The risk of bleeding is quadrupled compared to the esophagogastric area, with a mortality of up to 40%. The transjugular intrahepatic portosystemic shunt, should be considered in cases secondary to recurrent bleeding varices. We present a case report of an urological emergency of bleeding in a urinary diversion secondary to ectopic varices successfully treated through the placement of transjugular intrahepatic portosystemic shunt. The condition described here is rare, but important, as it can be a life-threatening complication of portal hypertension. This kind of complication should be known by urologic surgeons managing patients with urinary diversions.

scholarly journals Life-Threatening Bleeding from Peristomal Varices after Cystoprostatectomy: Multimodal Approach in a Cirrhotic, Encephalopathic Patient with Severe Portal Hypertension

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Sergej E. L. Staubli ◽  
Tobias Gramann ◽  
Christoph Schwab ◽  
David Semela ◽  
Lukas Hechelhammer ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Ileal Conduit ◽  
Case Reports ◽  
Portosystemic Shunt ◽  
Second Step ◽  
Multimodal Approach ◽  
Radical Cystoprostatectomy ◽  
Life Threatening ◽  
Intrahepatic Portosystemic Shunt ◽  
Cirrhotic Patients

The bleeding of peristomal varices due to a portosystemic shunt is rare but potentially life-threatening in cirrhotic patients with portal hypertension. The scarce case reports in the literature recommend transjugular intrahepatic portosystemic shunt (TIPS) to prevent further bleeding. We report on a 72-year-old man who was referred to our hospital because of life-threatening bleeding from peristomal varices, three years after radical cystoprostatectomy for invasive bladder cancer. CT imaging showed liver cirrhosis with a prominent portosystemic shunt leading to massively enlarged peristomal varices. TIPS was taken into consideration, but not possible due to hepatic encephalopathy (HE). Medical therapy with lactulose and the nonselective beta-blocker carvedilol was initiated to treat HE and portal hypertension. In a second step, the portosystemic shunt was percutaneously embolized. Here, we present a multimodal approach to treat intractable bleeding from peristomal varices in a patient with ileal conduit urinary diversion, not suitable for TIPS.

Risk Factors for Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt in Patients with Hepatocellular Carcinoma and Portal Hypertension

2015 ◽  
Vol 24 (3) ◽  
pp. 301-307 ◽  
Author(s):  
Jiannan Yao ◽  
Li Zuo ◽  
Guangyu An ◽  
Zhendong Yue ◽  
Hongwei Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Portal Hypertension ◽  
Hepatic Encephalopathy ◽  
Pressure Gradient ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Meld Score ◽  
Portosystemic Shunt ◽  
Portal Flow ◽  
Intrahepatic Portosystemic Shunt

Aims: This study aimed at assessing the risk factors for hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) in patients with hepatocellular carcinoma (HCC) and portal hypertension. Method: Consecutive patients (n=279) with primary HCC who underwent TIPS between January 1997 and March 2012 at a single institution were retrospectively reviewed. Patients were followed up for 2 years. Pre-TIPS, peri-TIPS and post-TIPS clinical variables were reviewed using univariate and multivariate analyses to identify risk factors for HE after TIPS. Results: The overall incidence of HE was 41% (114/279). Multivariate analysis showed an increased odds for HE in patients with: >3 treatments with transcatheter arterial chemoembolization (TACE) and/or trans-arterial embolization (TAE) (odds ratio [OR], 4.078; 95% confidence interval [95%CI], 1.748-9.515); hepatopetal portal flow (OR, 2.362; 95%CI, 1.032-5.404); high portosystemic pressure gradient (OR, 1.198; 95%CI, 1.073-1.336) and high pre-TIPS MELD score (OR, 1.693; 95%CI, 1.390-2.062). Odds for HE were increased 1.693 fold for each 1-point increase in the MELD score, and 1.198 fold for each 1-mmHg decrease in the post-TIPS portosystemic pressure gradient. Conclusion: The identification of clinical variables associated with increased odds of HE may be useful for the selection of appropriate candidates for TIPS. Results suggest that an inappropriate decrease in the portosystemic pressure gradient might be associated with HE after TIPS. In addition, >3 treatments with TACE/TAE, hepatopetal portal flow, and high MELD score were also associated with increased odds of HE after TIPS. Key words:  –  –  – .

Isolated Gastric Varices and Use of Balloon-occlusive Retrograde Transvenous Obliteration: A Case Report and Literature Review*

2016 ◽  
Vol 25 (1) ◽  
pp. 115-117
Author(s):  
Thomas R. McCarty ◽  
Mena Bakhit ◽  
Tarun Rustagi
Keyword(s):  
Treatment Approach ◽  
Alcoholic Cirrhosis ◽  
Gastric Varices ◽  
Portosystemic Shunt ◽  
Asian Countries ◽  
End Stage Liver Disease ◽  
Intrahepatic Portosystemic Shunt ◽  
Isolated Gastric Varices ◽  
Splenic Thrombosis ◽  
End Stage

Isolated gastric varices are far less prevalent in Western countries where the rate of splenic thrombosis is much lower. However, in Asian countries the entity is more common and therefore a more robust treatment approach has been developed. Balloon-occlusive retrograde transvenous obliteration (BRTO) was first described in 1984 and then revived in 1996. The procedure, while uncommon in the U.S. and not recognized by the AASLD practice guidelines, allows for direct exclusion from the portosystemic system. Here we describe the case of a patient with alcoholic cirrhosis decompensated by bleeding gastric varices treated with BRTO. Abbrevations: BRTO: balloon-occlusive retrograde transverse obliteration; EGD: esophagogastro-duodenoscopy; HE: hepatic encephalopathy; MELD: Model for End Stage Liver Disease; TIPS: transjugular intrahepatic portosystemic shunt.

scholarly journals MesoTIPS: Combined Approach for the Treatment of Portal Hypertension Secondary to Portal Vein Thrombosis – A Brief Report

2017 ◽  
Vol 01 (01) ◽  
pp. 20-26
Author(s):  
Abbas Chamsuddin ◽  
Lama Nazzal ◽  
Thomas Heffron ◽  
Osama Gaber ◽  
Raja Achou ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Vein Thrombosis ◽  
Intrahepatic Portosystemic Shunt ◽  
The Right ◽  
Minilaparotomy Approach ◽  
Mean Time

AbstractIntroduction: We describe a technique we call “Meso-transjugular intrahepatic portosystemic shunt (MTIPS)” for relief of portal hypertension secondary to portal vein thrombosis (PVT) using combined surgical and endovascular technique. Materials and Methods: Nine adult patients with PVT underwent transjugular intrahepatic portosystemic shunt through a combined transjugular and mesenteric approach (MTIPS), in which a peripheral mesenteric vein was exposed through a minilaparotomy approach. The right hepatic vein was accessed through a transjugular approach. Mechanical thrombectomy, thrombolysis, and angioplasty were performed when feasible to clear PVT. Results: All patients had technically successful procedures. Patients were followed up for a mean time of 13.3 months (range: 8 days to 3 years). All patients are still alive and asymptomatic. Conclusion: We conclude that MTIPS is effective for the relief of portal hypertension secondary to PVT.

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