Adult-onset portosystemic encephalopathy caused by patent ductus venosus successfully treated with endovascular coil embolization: a rare case report

Abstract

Background: Patent ductus venosus (PDV) is a congenital shunt between the portal vein (PV) and inferior vena cava (IVC). However, there are few reports on symptomatic adult-onset PDV, and the appropriate management of this condition remains unknown. In particular, there are few reports on the use of endovascular therapy for the treatment of patients with symptomatic adult-onset PDV. However, the strategies, indications, long-term efficacy, and safety of this therapy remain poorly understood. Here we report a rare case of adult-onset PDV successfully treated via endovascular coil embolization using a retrievable IVC filter.

Case presentation: A 35-year-old man with a clinical course of progressive general fatigue and ataxia for 3 months was diagnosed with depressive personality disorder in another hospital 2 months ago and then referred to our hospital for detailed examination and further treatment. Blood test results showed hyperammonemia, indicating hepatic encephalopathy. Contrast-enhanced multidetector computed tomography and transarterial portography revealed a portosystemic shunt that connected the left PV to IVC. Endovascular coil embolization was successfully performed after temporary balloon occlusion testing and the placement of a retrievable IVC filter. After the procedure, ammonia levels gradually reduced, and his symptoms improved without any postoperative complications. No clinical symptoms were observed at the 6-year clinical follow up.

Conclusion: This report supports the findings of other studies and offers a less invasive therapeutic option, thereby aiding clinicians in making appropriate treatment decisions for these patients.

Keywords: Endovascular coil embolization; Portosystemic encephalopathy; Symptomatic adult-onset patent ductus venosus.

Fig. 1

The findings of contrast-enhanced multidetector computed tomography (MDCT) and transcatheter angiogram. a, b Contrast-enhanced MDCT showing an abnormal venous connection between the left portal vein and the inferior vena cava (IVC; white arrows), suggestive of patent ductus venosus. c, d Elective superior mesenteric angiogram with delayed venous phase image and transfemoral venography showing the same findings as those of MDCT

Fig. 2

Temporary balloon occlusion testing was performed for 3 h. The laboratory test following temporary BOT shows decreased serum ammonia levels in SVC, portal vein, and IVC

Fig. 3

Coil embolization following placement of the IVC filter (white arrows)

Fig. 4

Coil embolization successfully performed using 18 coils