Brief communicationCerebral Edema and Hyperammonemia After Transjugular Intrahepatic Portosystemic Shunt Placement in a Cirrhotic Patient
Section snippets
Clinical Course
The patient was a 46-year-old man with a history of hepatitis C cirrhosis diagnosed 13 years prior, with refractory ascites and a right-sided pleural effusion consistent with hepatic hydrothorax. He had a history of hypertension, chronic kidney disease, and portal hypertension with grade III esophageal varices. As an outpatient he had been undergoing therapy with peginterferon alfa-2a and propranolol and was listed for liver transplantation with a Model for End-Stage Liver Disease (MELD) score
Discussion
This case demonstrates the development of severe hepatic encephalopathy with cerebral edema caused by hyperammonemia as a complication of TIPS in a patient with chronic liver disease with relatively preserved liver function. The development of hepatic encephalopathy after TIPS is common, occurring with a frequency of 10%–44%, although these data are primarily obtained for TIPS performed for refractory variceal hemorrhage.5, 6, 7, 8 In a series of 50 patients who underwent TIPS for refractory
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