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Case Reports
. 2020 Jul 2;15(9):1423-1427.
doi: 10.1016/j.radcr.2020.06.023. eCollection 2020 Sep.

TIPS to the rescue: Preoperative Transjugular Intrahepatic Portosystemic Shunt (TIPS) placement in a patient with caput medusae and colon cancer

Irfan Masood  1 , Arsalan Saleem  1 , Komal Malik  2 , Laila Rashidi  3 , Manoj Kathuria  1
Affiliations
Case Reports

TIPS to the rescue: Preoperative Transjugular Intrahepatic Portosystemic Shunt (TIPS) placement in a patient with caput medusae and colon cancer

Irfan Masood et al. Radiol Case Rep. .

Abstract

Abdominal surgery in patients with cirrhosis and portal hypertension remains a challenge due to higher risk of morbidity and mortality. Preoperative elective transjugular intrahepatic portosystemic shunt (TIPS) is increasingly being used in these patient population. Herein, we report a case of 65-year-old male with biopsy-proven ascending colon cancer and cirrhosis. As a sequalae of portal hypertension, patient also had large caput medusae which posed significant challenge to the surgical approach for resection of the colon cancer. The patient was managed initially with placement of TIPS to decompress the portal pressures and caput medusae and allow safe surgical field for curative resection of the colon cancer. Following this, the patient underwent uneventful laparoscopic right hemicolectomy.

Keywords: Caput medusae; Colon cancer; Portal hypertension; Transjugular intrahepatic portosystemic shunt.

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Figures

Fig 1
Fig. 1
Axial contrast-enhanced images of the abdomen and pelvis (a-c) show a recanalized umbilical vein (arrow) with extensive, dilated, and tortuous periumbilical and anterior abdominal wall venous collaterals (arrowhead) draining into the left inferior epigastric vein (curved arrow). Sagittal contrast-enhanced CT images (d and e) show a large recanalized umbilical vein (arrow) and periumbilical and abdominal wall venous collaterals (arrowhead).
Fig 2
Fig. 2
Intraprocedure angiographic images (a-e) show successful deployment of TIPS between the right hepatic vein (RHV) and right portal vein (RPV) (arrow). Trans-TIPS venogram (b and c) shows enlarged and tortuous recanalized umbilical vein (arrowheads). Fingal images (d and e) show successful placement of Amplatzer plug and coils (curved arrows) within the umbilical vein.
Fig 3
Fig. 3
At 2-month follow-up, axial contrast-enhanced CT images (a and b) show changes of TIPS (arrow) and streak artifact from umbilical vein Amplatzer plug and coils (arrowhead). Axial (c) and sagittal (d) CT images at the level of umbilicus show interval complete resolution of the varices.
See this image and copyright information in PMC

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