Early Hepatic Encephalopathy after a Transjugular Intrahepatic Portosystemic Shunt Procedure: Case Report  

作　　者：Miriam Viviane Baron Gabriela Di Lorenzo Garcia Scherer Michele Paula dos Santos Andres Felipe Mantilla Santamaria Cristine Brandenburg Isabel Cristina Reinheimer Marcus Vinicius de Mello Pinto Aline Ronis Sampaio Alexandre Gomes Sancho Alexandre Gomes Sancho Esteban Fortuny Pacheco Felice Picariello Danielle de Mello Florentino Joice Nedel Ott Carolina Gonçalves Pinheiro Nathália Ken Pereira Iketani Sonia Carvalho Patrícia Froes Meyer Bartira Ercília Pinheiro da Costa Miriam Viviane Baron;Gabriela Di Lorenzo Garcia Scherer;Michele Paula dos Santos;Andres Felipe Mantilla Santamaria;Cristine Brandenburg;Isabel Cristina Reinheimer;Marcus Vinicius de Mello Pinto;Aline Ronis Sampaio;Alexandre Gomes Sancho;Alexandre Gomes Sancho;Esteban Fortuny Pacheco;Felice Picariello;Danielle de Mello Florentino;Joice Nedel Ott;Carolina Gonçalves Pinheiro;Nathália Ken Pereira Iketani;Sonia Carvalho;Patrícia Froes Meyer;Bartira Ercília Pinheiro da Costa(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;School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS), Porto Alegre, Rio Grande do Sul, Brazil;Industrial University of Santander (UIS), Bucaramanga, Colombia;University of Vale do Acaraú (IDJ/UVA), Ceará, Brazil;Celulare Institute, Rio de Janeiro, Brazil;Unigranrio, Rio de Janeiro, Brazil;Universidad Finis Terrae, Santiago, Chile;Università degli Studi di Napoli Federico II, Napoli, Italy;Uniredentor University, Rio de Janeiro, Brazil;Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC (FABC), São Paulo, Brazil;Hospital Beneficiente Portuguesa of Belém, Pará, Brazil;Rigshospital, Copenhagen East, København, Denmark;Centro Universitário do Rio Grande do Norte, Natal, Brazil)

机构地区：[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]Industrial University of Santander (UIS), Bucaramanga, Colombia [4]University of Vale do Acaraú (IDJ/UVA), Ceará, Brazil [5]Celulare Institute, Rio de Janeiro, Brazil [6]Unigranrio, Rio de Janeiro, Brazil [7]Universidad Finis Terrae, Santiago, Chile [8]Università degli Studi di Napoli Federico II, Napoli, Italy [9]Uniredentor University, Rio de Janeiro, Brazil [10]Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC (FABC), São Paulo, Brazil [11]Hospital Beneficiente Portuguesa of Belém, Pará, Brazil [12]Rigshospital, Copenhagen East, København, Denmark [13]Centro Universitário do Rio Grande do Norte, Natal, Brazil

出　　处：《Open Journal of Gastroenterology》2021年第6期81-88,共8页肠胃病学期刊（英文）

摘　　要：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.</span><b> </b><span style="font-family:Verdana;">Male, elderly, and ex-alcoholic, diagnosed with liver cirrho</span><span style="font-family:Verdana;">sis, ascites, and esophageal varices. He underwent transjugular intrahepatic portosystemic shunt due to portal hypertension and returned to the hospital</span> <span style="font-family:Verdana;">after 24 hours with agitation and mental confusion. He had a bowel move</span><span style="font-family:Verdana;">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.</span><b> </b><span style="font-family:Verdana;">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.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.</span><b> </b><span style="font-family:Verdana;">Male, elderly, and ex-alcoholic, diagnosed with liver cirrho</span><span style="font-family:Verdana;">sis, ascites, and esophageal varices. He underwent transjugular intrahepatic portosystemic shunt due to portal hypertension and returned to the hospital</span> <span style="font-family:Verdana;">after 24 hours with agitation and mental confusion. He had a bowel move</span><span style="font-family:Verdana;">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.</span><b> </b><span style="font-family:Verdana;">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.

关 键 词：ASCITES HYPERNATREMIA Portasystemic Shunt Transjugular Intrahepatic Hepatic Encephalopathy 

分 类 号：R57[医药卫生—消化系统]