Portosystemic shunt syndrome in liver cirrhosis

Case contributed by Bahman Rasuli


Known case of cryptogenic cirrhosis from 10 years ago referred with progressive deterioration of hepatic function and hepatic encephalopathy.

Patient Data

Age: 30 years
Gender: Male

The liver has a nodular surface and atrophic, in keeping with cirrhosis


Patent portal vein as well as splenic and SMV

Minimal ascetic free fluid

Multiple esophageal collaterals continuing along the cardia to form collaterals in the lesser curvature of the stomach

Gastroesophageal collateral draining into the main portal vein next to hepatic hilum

Multiple tortuous dilated splenic collateral veins draining into the left common iliac vein

Recanalized dilated paraumbilical vein with downward courses along with anterior abdominal wall and drained into the left external iliac vein

Intrahepatic portosystemic venous shunt in the subcapsular area of the liver segment IVa

No communication between the splenic vein and the left renal vein

Right-sided pleural effusion.

Case Discussion

Liver cirrhosis is associated with progressive portal hypertension followed by the formation of portosystemic shunts in order to reduce the portal pressure, but also act as bypasses to normal liver flow. when the shunts enlarged enough, complications including variceal bleeding, hepatic encephalopathy, deterioration of liver function and, portal vein thrombosis will appear.

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