Hemodialysis-related portosystemic encephalopathy after transjugular intrahepatic portosystemic shunt: A case report

BO PENGYI REN^*

• Chengdu Second People's Hospital, Chengdu, China

BACKGROUND Hemodialysis-related portosystemic encephalopathy (HRPSE) is a clinical phenomenon in which portosystemic encephalopathy develops typically caused by hemodialysis-induced alterations in portosystemic blood flow. Essentially, HRPSE represents a form of dialysis-induced hepatic encephalopathy. Most HRPSE cases involve spontaneous portosystemic shunts in vivo. However herein we present a rare case of the portosystemic shunt tract being opened by transjugular intrahepatic portosystemic shunt (TIPS) in a cirrhotic patient to alleviate the symptoms of refractory ascites, in which encephalopathy symptoms recurred during the maintenance hemodialysis for this patient's chronic renal failure. CASE PRESENTATION A 71-year-old female with cirrhosis and stage G5 chronic kidney disease (CKD) was admitted. A TIPS stent was placed because of portal hypertension with refractory ascites. Due to preexisting CKD requiring maintenance hemodialysis, hemodialysis continued post-TIPS. During the latter half of dialysis sessions at 2 weeks post-TIPS, the patient exhibited recurrent hepatic encephalopathy symptoms, including sluggish responses, incoherent answers, and progressive consciousness impairment. After excluding other neurological disorders, HRPSE was diagnosed. Ammonia-lowering interventions and dialysis prescription modification reduced encephalopathy incidence. CONCLUSION TIPS requires careful evaluation in cirrhotic patients with concomitant CKD, and HRPSE should be considered in decompensated cirrhosis management.