Case reports in gastrointestinal medicine
Refractory Post-TIPS Hepatic Encephalopathy Complicated by Small Bowel Obstruction: A Therapeutic Dilemma
By Ismail A, Alnakeb A, Altarawneh S and 1 others.
Abstract
Introduction
Refractory hyperammonemic encephalopathy in cirrhosis presents a therapeutic challenge, particularly in post-TIPS patients or with contraindications to standard therapies. We report a fatal case complicated by small bowel obstruction (SBO), highlighting the limitations of current management strategies.
Case presentation
A 69-year-old male with decompensated NASH cirrhosis and recent TIPS revision for shunt stenosis developed SBO. He presented with severe encephalopathy (GCS 5), seizures, and MRI-confirmed cerebral edema. Due to SBO, lactulose and rifaximin were not effective. Despite aggressive dialysis with continuous venovenous hemodialysis (CVVHD) reducing ammonia from 447 to 160 μmol/L, he progressed to irreversible cerebral edema and met brain death criteria.
