Placement of transjugular intrahepatic
portosystemic shunt via the left hepatic vein under sonographic guidance in a patient with right hemihepatectomy.
Ganguli, "Reduction in portal venous pressure by transjugular intrahepatic
portosystemic shunt for treatment of hemorrhagic stomal varices," American Journal of Roentgenology, vol.
Intrahepatic
portosystemic shunts are rare vascular abnormalities that may incidentally be detected in asymptomatic patients.
Portopulmonary hypertension secondary to congenital extrahepatic
portosystemic shunt with heterotaxy and polysplenia: A cause of sudden death in an infant.
Damiano et al., "Neoadjuvant transjugular intrahepatic
portosystemic shunt: a solution for extrahepatic abdominal operation in cirrhotic patients with severe portal hypertension," Journal of the American College of Surgeons, vol.
Head pressing can be a sign of a liver shunt, also called
portosystemic shunt. A liver shunt is a blood vessel that bypasses the liver and prevents blood from being detoxified.
The patient had an extensive and complex medical history that included non-Hodgkin's lymphoma, now in remission; an illness diagnosed by some as POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, circulating M protein, and skin changes) and by other physicians as Waldenstrom's macroglobulinemia; hepatic cirrhosis with a TIPS procedure (transjugular intrahepatic
portosystemic shunt), a TIPS revision, and at least one episode of hepatic encephalopathy; systemic arterial hypertension; diabetes mellitus; and mild chronic renal insufficiency.
Endoscopic band ligations were done in oesophageal variceal patients who were successfully managed, while 5(20%) patients required
portosystemic shunt surgeries.
(8) Transjugular intrahepatic
portosystemic shunt (TIPS), selective embolization, or surgical shunt solutions should be considered in cases of recurrent bleeding varices.
Bleeding gastric varices should be treated with octreotide and balloon tamponade followed with either a transjugular intrahepatic
portosystemic shunt or surgery.
[6] When biliary intervention is required, it is generally recommended that a
portosystemic shunt (PSS) be performed before the hepaticojejunostomy to avoid the risk of major haemorrhage from the abundant network of venous collaterals around the common bile duct.