A case of refractory hepatic encephalopathy successfully treated with simultaneous balloon-occluded retrograde transvenous obliteration of mesocaval and splenorenal shunt

• Published in: Kanzo Vol. 60; no. 8; pp. 302 - 309
• Main Authors: Kimura, Haruna, Waguri, Nobuo, Osaki, Akihiko, Koyama, Kyutaro, Mito, Masaki, Yakubo, Shunta, Morita, Shinichi, Kimura, Atsushi, Kawata, Yuzo, Watanabe, Yusuke, Sato, Munehiro, Aiba, Tsuneo, Yoneyama, Osamu, Furukawa, Koichi
• Format: Journal Article
• Language: Japanese
• Published: The Japan Society of Hepatology 01.08.2019
• Subjects: balloon-occluded retrograde transvenous obliteration (BRTO); hepatic encephalopathy; liver cirrhosis; pancreas head cancer; portosystemic shunts
• ISSN: 0451-4203; 1881-3593
• DOI: 10.2957/kanzo.60.302

A 56-year-old man with pancreatic head cancer and liver cirrhosis was admitted because of intractable hepatic encephalopathy. Computed tomography revealed cirrhosis and the three following routes of portosystemic shunting: splenorenal, mesocaval, and mesorenal shunts. At the initial diagnosis of pancreatic cancer, it was judged that a radical operation could not be performed because his hepatic residual function was poor (Child-Pugh C grade). After some time, hepatic encephalopathy became apparent, and he often required hospitalization despite ongoing medical treatment. After obtaining informed consent, we performed balloon-occluded retrograde transvenous obliteration (BRTO) of the splenorenal and mesocaval shunts in one series. We simultaneously performed concomitant partial splenic embolization to reduce the portal venous pressure. Plasma ammonia levels normalized immediately, and he was discharged from the hospital 9 days after BRTO. He continues to visit our hospital for follow-up visits and has not experienced subsequent recurrence of hepatic encephalopathy. His Child-Pugh score decreased from 12 to 7, and his quality of life improved. BRTO could be useful for hepatic encephalopathy refractory to medical treatment.