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Kawahara Y, Tanaka Y, Isoi N, et al. Direct intrahepatic portocaval shunt for refractory hepatic hydrothorax: a case report. Acute Med Surg. 2016;4(3):306-310doi: 10.1002/ams2.257.
Kawahara, Y., Tanaka, Y., Isoi, N., Hatanaka, K., Yamada, K., Yamamoto, M., Okamura, T., Kaji, T., Sakamoto, T., Saitoh, D., & Ikeuchi, H. (2017). Direct intrahepatic portocaval shunt for refractory hepatic hydrothorax: a case report. Acute medicine & surgery, 4(3), 306-310. https://doi.org/10.1002/ams2.257
Kawahara, Yo, et al. "Direct intrahepatic portocaval shunt for refractory hepatic hydrothorax: a case report." Acute medicine & surgery vol. 4,3 (2017): 306-310. doi: https://doi.org/10.1002/ams2.257
Kawahara Y, Tanaka Y, Isoi N, Hatanaka K, Yamada K, Yamamoto M, Okamura T, Kaji T, Sakamoto T, Saitoh D, Ikeuchi H. Direct intrahepatic portocaval shunt for refractory hepatic hydrothorax: a case report. Acute Med Surg. 2016 Dec 09;4(3):306-310. doi: 10.1002/ams2.257. eCollection 2017 Jul. PMID: 29123879; PMCID: PMC5674466.
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Acute Med Surg. 2016 Dec 09;4(3):306-310. doi: 10.1002/ams2.257. eCollection 2017 Jul.

Direct intrahepatic portocaval shunt for refractory hepatic hydrothorax: a case report.

Acute medicine & surgery

Yo Kawahara, Yoshihiro Tanaka, Naoaki Isoi, Kohsuke Hatanaka, Kentaro Yamada, Masayoshi Yamamoto, Teppei Okamura, Tatsumi Kaji, Toshihisa Sakamoto, Daizoh Saitoh, Hisashi Ikeuchi

Affiliations

  1. Department of Traumatology and Critical Care Medicine National Defense Medical College Saitama Japan.
  2. Department of Radiology National Defense Medical College Saitama Japan.
  3. Division of Traumatology Research Institute National Defense Medical College Saitama Japan.

PMID: 29123879 PMCID: PMC5674466 DOI: 10.1002/ams2.257

Abstract

CASE: A 64-year-old man with complaints of dyspnea and orthopnea secondary to a hepatic hydrothorax refractory to diuretic medication underwent the transjugular intrahepatic portosystemic shunt (TIPS) procedure to decrease the portal vein pressure. The TIPS procedure failed due to severe liver stiffness. Direct intrahepatic portocaval shunt (DIPS), a modified TIPS procedure that directly inserts a stent from the inferior vena cava to the portal vein, was successfully carried out.

OUTCOME: The DIPS procedure significantly decreased the patient's pleural effusion and respiratory symptoms.

CONCLUSION: No other medical treatment is available to control refractory pleural effusion caused by portal hypertension; however, the TIPS (or DIPS) procedure can be successfully carried out in patients <60 years old with a Model of End-Stage Liver Disease score <15.

Keywords: Ascites; hypertension, portal; liver cirrhosis; pleural effusion; portosystemic shunt, transjugular intrahepatic

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