Transjugular Intrahepatic Portosystemic Shunt (TIPS) for Hepatic Sinusoidal Obstruction Syndrome with Primary Biliary Cholangitis and Alcoholic Liver Disease: A Case Report

Pei Yang¹Feng Zhang^2*Feng Wang^1*Yang He¹Yao Wang¹

• ¹Second People's Hospital of Qujing City, Qujing, China
• ²Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital Department of Gastroenterology, Nanjing, China

This article reports the case of a 73-year-old male patient with a 50-year history of long-term alcohol abuse ( with daily intake of 250g) combined with primary biliary cholangitis (PBC, AMA-M2 positive). The patient recently developed refractory ascites and manifestations of portal hypertension (hepatic venous pressure gradient, HVPG: 17.3 mmHg). Liver biopsy revealed characteristic sinusoidal dilation and congestion, fibrosis, and erythrocyte extravasation. It was discovered that the patient had a history of consuming Gynura segetum (a traditional Chinese herb) for one year. Based on clinical presentation and diagnostic findings, the final diagnosis included: 1) Hepatic veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS), 2) Portal hypertension, 3) Primary biliary cholangitis (PBC), and 4) Alcoholic cirrhosis. After poor response to medical treatment, transjugular intrahepatic portosystemic shunt (TIPS) was performed, resulting in significant improvement (postoperative portal pressure gradient, PPG, decreased to 8 mmHg with complete resolution of ascites). During a 6-month follow-up, liver function showed marked improvement, with Child-Pugh score improving from class C (11 points) to class A (6 points).