Clinical Journal of Gastroenterology

, Volume 11, Issue 2, pp 156–160 | Cite as

Proximal total splenic artery embolization for refractory hepatic encephalopathy

  • Harufumi Maki
  • Junichi Kaneko
  • Junichi Arita
  • Nobuhisa Akamatsu
  • Yoshihiro Sakamoto
  • Kiyoshi Hasegawa
  • Sumihito Tamura
  • Hidemasa Takao
  • Eisuke Shibata
  • Norihiro Kokudo
Case Report

Abstract

A Japanese woman with a history of Kasai operation for biliary atresia had living-donor liver transplantation at the age of 22. The first episode of refractory HE and late cellular rejection was treated by a high dose of methylprednisolone. The second episode of refractory HE was treated by balloon-occluded retrograde transvenous obliteration for a spleno-renal shunt. However, the third episode of refractory HE occurred 11 years after liver transplantation. The liver cirrhosis and hypersplenism were present with a Child–Pugh score of C-10. Although portal vein flow was hepatopetal, superior mesenteric vein flow regurgitated. We performed proximal total splenic artery embolization (TSAE). Superior mesenteric vein flow changed to a hepatopetal direction and she became clear. At a year after proximal TSAE, her spleen volume had decreased to 589 mL (20% decrease) on computed tomography. She is well and has a Child–Pugh score of 8 without overt HE. We report the first case of refractory HE treated by proximal TSAE that is a possible less invasive treatment option for a selected patient.

Keywords

Proximal total splenic artery embolization Living-donor liver transplantation Refractory hepatic encephalopathy Superior mesenteric vein Hepatofugal 

Notes

Compliance with ethical standards

Conflict of interest

Harufumi Maki, Junichi Kaneko, Junichi Arita, Nobuhisa Akamatsu, Yoshihiro Sakamoto, Kiyoshi Hasegawa, Sumihito Tamura, Hidemasa Takao, Eisuke Shibata, and Norihiro Kokudo that they have no conflicts of interest.

Human Rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed Consent

Informed consent was obtained from all patients for being included in the study.

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Copyright information

© Japanese Society of Gastroenterology 2017

Authors and Affiliations

  • Harufumi Maki
    • 1
  • Junichi Kaneko
    • 1
  • Junichi Arita
    • 1
  • Nobuhisa Akamatsu
    • 1
  • Yoshihiro Sakamoto
    • 1
  • Kiyoshi Hasegawa
    • 1
  • Sumihito Tamura
    • 1
  • Hidemasa Takao
    • 1
    • 2
  • Eisuke Shibata
    • 1
    • 2
  • Norihiro Kokudo
    • 1
  1. 1.Hepato-Biliary-Pancreatic Surgery Division, and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
  2. 2.Department of RadiologyThe University of TokyoTokyoJapan

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