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Case Reports
. 2006 Jan 21;12(3):493-5.
doi: 10.3748/wjg.v12.i3.493.

TIPSS for variceal hemorrhage after living related liver transplantation: a dangerous indication

Peter Schemmer  1 , Boris Radeleff, Christa Flechtenmacher, Arianeb Mehrabi, Gotz M Richter, Markus W Buchler, Jan Schmidt
Affiliations
Case Reports

TIPSS for variceal hemorrhage after living related liver transplantation: a dangerous indication

Peter Schemmer et al. World J Gastroenterol. .

Abstract

The introduction of transjugular intrahepatic portal-systemic stent-shunt (TIPSS) has been a major breakthrough in the treatment of portal hypertension, which has evolved to a large extent, into a routine procedure. A 21-year-old male patient with progressive graft fibrosis/cirrhosis requiring TIPSS for variceal hemorrhage in the esophagus due to portal hypertension was unresponsive to conventional measures two years after living related liver transplantation (LDLT). Subsequently, variceal hemorrhage was controlled, however, liver function decreased dramatically with consecutive multi organ failure. CT scan revealed substantial necrosis in the liver. The patient underwent successful "high urgent" cadaveric liver transplantation and was discharged on postoperative d 20 in a stable condition.

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Figures

Figure 1
Figure 1
Pre-TIPSS MRI/angiography and post-TIPSS macroscopy of the liver. Pictures illustrating pre-TIPSS inhomogeneous intrahepatic parenchyma texture (A); clinically irrelevant stenosis of the hepatic artery (B) and macroscopic aspect of the liver after TIPSS and organ failure due to substantial necrosis in areas where circulation was compromised before TIPSS (C).
Figure 2
Figure 2
TIPSS-placement. Picture illustrating correctly placed TIPSS.
Figure 3
Figure 3
Spiral-CT scan after TIPSS was established. Spiral-CT after TIPSS revealed substantial necrosis at the time of liver failure.
See this image and copyright information in PMC

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