Successful occlusion of spontaneous portosystemic shunts leading to encephalopathy in a non-cirrhotic patient by using the amplatzer vascular plug

Abstract

A 55-year-old woman presented with recurrent, recently aggravated encephalopathic episodes. However, the patient had no evidence of liver cirrhosis, and her serum ammonia level was high. An abdominal computed tomography (CT) scan revealed two portal-systemic venous shunts and, accordingly, she was diagnosed as having non-cirrhotic portal-systemic encephalopathy due to portal-systemic shunts. The shunts were successfully occluded using Amplatzer vascular plugs, and this led to a normalization of her blood ammonia levels immediately after occlusion. Over a 3-month follow-up, the patient experienced no complications or symptoms, and no shunt recanalization was detected by CT. The described case demonstrates that the Amplatzer vascular plug offers a useful option for occluding portal-systemic shunts responsible for encephalopathy.