SURGICAL SALVAGE AFTER FAILED TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMICSHUNTING

The creation of an intrahepatic portosystemic shunt using an expandabl e stent introduced by a transjugular route constitutes an alternative to surgical shunts for the management of portal hypertension. A 61-yea r-old woman with Child C cryptogenic cirrhosis and acute variceal blee ding presented a massive haemoperitoneum due to a tear at the portal v ein confluence during a failed attempt at TIPS. Surgical salvage consi sting in an end-to-side portocaval shunt was performed under adverse c onditions because of massive haemorrhagic infiltration of the hepatic pedicle. The patient died shortly after surgery of irreversible shock. A 61-year-old male with Child C alcoholic liver disease underwent an urgent TIPS procedure for recurrent variceal bleeding. However, the st ent was placed too distally, at the splenomesenteric junction, causing splenic and portal vein thrombosis. After surgical removal of the imp acted stent and thrombectomy, an end-to-side portocaval shunt was perf ormed. The patient died 1 month later of infected ascites. Although se rious procedural complications are uncommon in expert hands, transjugu lar intrahepatic portosystemic shunting is an invasive technique that is associated with potentially fatal complications.