A case of refractory hepatic encephalopathy due to the mesenteric shunt, successfully treated by percutaneous transhepatic portal venous collateral obliteration

A 67-year-old woman, previously treated for alcoholic liver cirrhosis and diabetes mellitus, was admitted to our hospital because of exacerbation of hepatic encephalopathy and diabetes mellitus but she gradually lapsed into hepatic coma. A giant collateral circulation was found traversing the splenic and mesenteric veins and flowing into the inferior vena cava. Collateral circulation was attempted via a percutaneous transhepatic portal route for embolization. Three days after admission, hemorrohage occurred at the hepatic puncture. A giant arterioportal shunt (A-P shunt) developed, disobliterating the collateral circulation. The artery of the A-P shunt was embolized, resulting in hemostasis. The patient regained consciousness and the ability to converse normally three and seven days, respectively, after abdominal angiography with a Hasegawa Scale of 12. We reported a case of refractory hepatic encephalopathy for which percutaneous transhepatic obliteration of the portal collateral circulation was proven to be effective.