Vascular Plug-Assisted Retrograde Obliteration (PARTO) of Right Mesorenal Shunt for Hepatic Encephalopathy: An Uncommon Site of a Spontaneous Portosystemic Shunt in Cirrhosis

A 47-year-old male patient with alcohol-related cirrhosis presented to the liver clinic complaint of repeated episodes hepatic encephalopathy (HE) manifested as a disturbance in sleep pattern, hypersomnia, impaired memory, mental confusion, and drowsiness (West Haven grade II/III). On evaluation, had Child-Pugh score 6 (CTP-A), hyperammonemia (>200 µg/dL), small low-risk esophageal varices, splenomegaly, large right mesorenal shunt (MRS) afferent from superior mesenteric vein draining into renal ([Fig. 1]). Vascular plug-assisted retrograde transvenous obliteration (PARTO) MRS was planned since HE persisted despite optimization standard medical treatment.