Symptomatic hepatic hydrothorax successfully treated with transjugular intrahepatic portosystemic shunt (TIPS)–role of titration of portosystemic gradient reduction to avoid post-TIPS encephalopathy
نویسندگان
چکیده
KEY CLINICAL MESSAGE We describe a challenging case of hepatic hydrothorax secondary to nonalcoholic steatohepatitis cirrhosis. Our management involved successfully treating the hydrothorax with a transjugular intrahepatic porto-systemic shunt but having to manage the subsequent complication of hepatic encephalopathy. We conclude with a review of the available literature.
منابع مشابه
Severe Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt (TIPS): Value of Shunt Reduction and Occlusion
Hepatic encephalopathy (HE) after implantation of the transjugular intrahepatic portosystemic Shunt (TIPS) is generally well treatable. Severe and refractory HE might be treated with shunt reduction or occlusion. We performed a retrospective study between January 2004 and January 2016. Out of 456 TIPS implantations, 17 patients (3,7%) were treated with shunt reduction and 6/17 patients with add...
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BACKGROUND In refractory ascites/hydrothorax (RA), uncovered transjugular intrahepatic portosystemic shunt (TIPS) is shown to be superior to large-volume therapeutic paracentesis (LVP) for long-term control of ascites, but at a cost of increased risk of hepatic encephalopathy (HE). Use of covered TIPS has shown to improve shunt patency rate over uncovered TIPS. This retrospective analysis was p...
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Since the introduction of transjugular intrahepatic portosystemic shunt (TIPS) 10 years ago, it has been used increasingly in the management of portal hypertension and its complications. TIPS is now considered the procedure of choice for management of refractory variceal bleeding. Its role in the management of refractory ascites, hepatic hydrothorax, hepatorenal syndrome, and hepatopulmonary sy...
متن کاملTransjugular intrahepatic portosystemic shunt.
The transjugular intrahepatic portosystemic shunt (TIPS) is an interventional treatment resulting in decompression of the portal system by creation of a side-to-side portosystemic anastomosis. Since its introduction 16 years ago, more than 1,000 publications have appeared demonstrating broad acceptance and increasing clinical use. This review summarizes our present knowledge about technical asp...
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Introduction: Hepatic encephalopathy (HE) is a frequent consequence of transjugular intrahepatic portosystemic shunt (TIPS) placement and a major cause of morbidity, mortality and healthcare utilization in cirrhotic patients. The prevention of post-TIPS HE is mainly achieved by a careful selection of patients before the procedure. A relationship between the occurrence of HE and a low post-TIPS ...
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