Severe Hepatic Encephalopathy after the Transjugular Intrahepatic Portosystemic Shunt

Aim. To demonstrate a case of severe hepatic encephalopathy with focal neurological symptoms in the early postoperative period after transjugular intrahepatic portosystemic shunting (TIPS). Key points. TIPS is the most common and effective pathogenetically justified shunting method for correcting portal hypertension in liver cirrhosis. The modern transplantology doctrine dictates an increasing need for TIPS as a bridge technology that improves patient survival on the liver transplant waiting list. The progression of hepatic encephalopathy in the postoperative period following this intervention is the main expected adverse consequence of the procedure. Timely diagnosis of worsening neuropsychiatric function in patients who have undergone TIPS and its effective restoration are pressing issues in contemporary gastroenterological practice. Screening examinations to detect hepatic encephalopathy should be regularly performed for all patients, who have undergone TIPS, regardless of the timing of the procedure. Complex therapy, including ornithine, lactulose, and antibacterial drugs to suppress excessive bacterial growth in the intestine, should be prescribed from the first days after the intervention. Since suppressing excessive bacterial growth in the intestine in patients with hepatic encephalopathy is an independent pathogenetically based therapeutic target, cyclical use of antibacterial agents for intestinal sanitation in patients with TIPS significantly enhances the effectiveness of controlling hepatic encephalopathy. Conclusion. This case clearly demonstrates that the foundation of successful treatment for a patient with liver cirrhosis lies in the continuity and interconnection of all stages of care provision. Keywords: hepatic encephalopathy, transjugular intrahepatic portosystemic shunt, TIPS, portal hypertension, liver cirrhosis, liver transplant waiting list, excessive bacterial growth, cyclical bowel sanitation