N-acetylcysteine therapy for ischaemic hepatic failure: a successful antidote

Acute liver failure (ALF) is characterised by severe liver injury with the onset of coagulopathy (INR ≥1.5) and encephalopathy in the absence of pre-existing liver disease. It is associated with a high mortality rate of 10-57%, which is largely driven by multi-organ failure, sepsis and cardiac arrhythmia. Current management focuses on identifying and treating the aetiology, providing supportive care and monitoring liver function. The use of N-acetylcysteine (NAC) therapy is well-studied in the treatment of paracetamol toxicity but is controversial in other causes of ALF. We reported the first case of ischaemic hepatic failure secondary to prolonged portal vein occlusion treated with 72 hours of NAC therapy. Although ischaemic hepatopathy is a relatively uncommon cause of ALF, it is associated with a high mortality rate. The case highlights how early use of NAC therapy may improve hepatic serology biomarkers and should warrant consideration in ALF secondary to ischaemic hepatopathy.

Delayed Splenic Rupture After a Percutaneous Transsplenic Approach to Treat Portal Vein Occlusion

Purpose: To report a case of delayed splenic rupture after percutaneous transsplenic portal vein stent deployment. Case Report: A 72-year-old male patient presented at a medical center with abdominal pain and reduced liver function according to laboratory tests. Due to a history of right hemihepatectomy and left portal vein occlusion, the percutaneous transhepatic approach was considered inappropriate. Instead, percutaneous transsplenic access was selected as a suitable procedure for portal vein catheterization. Eight days following the procedure, the patient developed abdominal pain, and a computed tomography scan showed a small splenic pseudoaneurysm that was underappreciated at the time. Patient suffered acute splenic rupture 32 days post-procedure. Subsequent embolization was performed, achieving complete hemostasis. Conclusion: The transsplenic approach should be considered when the transhepatic or transjugular approach is unfeasible or difficult to implement. A careful plugging of the puncture tract is necessary to prevent or minimize hemorrhage from the splenic access tract. In addition, careful serial follow-up computed tomography should be used to evaluate the splenic puncture tract.