Management of Bleed from Percutaneous Portal Puncture Site (post-BRTO) by Trans-jugular-Trans-Hepatic Embolization

We report the case of an elderly male, who was a known case of chronic liver parenchymal disease. He presented with a history of melena for 2 weeks and upper-GI endoscopy revealed fundal varices. He was planned for BRTO. Along with BRTO, a percutaneous trans-hepatic puncture of a branch of the right...

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Autores principales:	Raghav Seth, Arun Gupta, Ajit Yadav
Formato:	article
Lenguaje:	EN
Publicado:	Thieme Medical Publishers, Inc. 2021
Materias:	brto portal vein embolization Medical physics. Medical radiology. Nuclear medicine R895-920
Acceso en línea:	https://doaj.org/article/4865cea59fff48c5a0d3242de2571b40
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spelling	oai:doaj.org-article:4865cea59fff48c5a0d3242de2571b402021-11-12T23:45:49ZManagement of Bleed from Percutaneous Portal Puncture Site (post-BRTO) by Trans-jugular-Trans-Hepatic Embolization2456-486910.1055/s-0041-1739044https://doaj.org/article/4865cea59fff48c5a0d3242de2571b402021-11-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1739044https://doaj.org/toc/2456-4869We report the case of an elderly male, who was a known case of chronic liver parenchymal disease. He presented with a history of melena for 2 weeks and upper-GI endoscopy revealed fundal varices. He was planned for BRTO. Along with BRTO, a percutaneous trans-hepatic puncture of a branch of the right portal vein was also performed for proper embolization of the varices. The trans-hepatic puncture-tract was embolized after the procedure. However, after 24 hours of the procedure, the patient developed hypotension and abdominal distension due to hemorrhage from the portal puncture site. Portal-venography was performed via the trans-jugular-trans-hepatic route to confirm the source of hemorrhage and embolization of the culprit portal venous branch was performed via the same route. The patient was stable after the procedure. Various interventional procedures via the trans-jugular route have been routinely described in the literature, including trans-jugular liver biopsies, placement of TIPSS shunts and endovascular interventions for haemodialysis. However, the literature on trans-jugular embolization of portal vein is scarce. This case describes the unexpected clinical situation, in the form of bleeding from the portal puncture site, despite embolization of the trans-hepatic tract after BRTO. Finally, a creative solution was thought of and trans-jugular embolization of the portal vein was performed, which succeeded in terminating the ongoing bleeding from the portal vein.Raghav SethArun GuptaAjit YadavThieme Medical Publishers, Inc.articlebrtoportal vein embolizationMedical physics. Medical radiology. Nuclear medicineR895-920ENJournal of Clinical Interventional Radiology ISVIR (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	brto portal vein embolization Medical physics. Medical radiology. Nuclear medicine R895-920
spellingShingle	brto portal vein embolization Medical physics. Medical radiology. Nuclear medicine R895-920 Raghav Seth Arun Gupta Ajit Yadav Management of Bleed from Percutaneous Portal Puncture Site (post-BRTO) by Trans-jugular-Trans-Hepatic Embolization
description	We report the case of an elderly male, who was a known case of chronic liver parenchymal disease. He presented with a history of melena for 2 weeks and upper-GI endoscopy revealed fundal varices. He was planned for BRTO. Along with BRTO, a percutaneous trans-hepatic puncture of a branch of the right portal vein was also performed for proper embolization of the varices. The trans-hepatic puncture-tract was embolized after the procedure. However, after 24 hours of the procedure, the patient developed hypotension and abdominal distension due to hemorrhage from the portal puncture site. Portal-venography was performed via the trans-jugular-trans-hepatic route to confirm the source of hemorrhage and embolization of the culprit portal venous branch was performed via the same route. The patient was stable after the procedure. Various interventional procedures via the trans-jugular route have been routinely described in the literature, including trans-jugular liver biopsies, placement of TIPSS shunts and endovascular interventions for haemodialysis. However, the literature on trans-jugular embolization of portal vein is scarce. This case describes the unexpected clinical situation, in the form of bleeding from the portal puncture site, despite embolization of the trans-hepatic tract after BRTO. Finally, a creative solution was thought of and trans-jugular embolization of the portal vein was performed, which succeeded in terminating the ongoing bleeding from the portal vein.
format	article
author	Raghav Seth Arun Gupta Ajit Yadav
author_facet	Raghav Seth Arun Gupta Ajit Yadav
author_sort	Raghav Seth
title	Management of Bleed from Percutaneous Portal Puncture Site (post-BRTO) by Trans-jugular-Trans-Hepatic Embolization
title_short	Management of Bleed from Percutaneous Portal Puncture Site (post-BRTO) by Trans-jugular-Trans-Hepatic Embolization
title_full	Management of Bleed from Percutaneous Portal Puncture Site (post-BRTO) by Trans-jugular-Trans-Hepatic Embolization
title_fullStr	Management of Bleed from Percutaneous Portal Puncture Site (post-BRTO) by Trans-jugular-Trans-Hepatic Embolization
title_full_unstemmed	Management of Bleed from Percutaneous Portal Puncture Site (post-BRTO) by Trans-jugular-Trans-Hepatic Embolization
title_sort	management of bleed from percutaneous portal puncture site (post-brto) by trans-jugular-trans-hepatic embolization
publisher	Thieme Medical Publishers, Inc.
publishDate	2021
url	https://doaj.org/article/4865cea59fff48c5a0d3242de2571b40
work_keys_str_mv	AT raghavseth managementofbleedfrompercutaneousportalpuncturesitepostbrtobytransjugulartranshepaticembolization AT arungupta managementofbleedfrompercutaneousportalpuncturesitepostbrtobytransjugulartranshepaticembolization AT ajityadav managementofbleedfrompercutaneousportalpuncturesitepostbrtobytransjugulartranshepaticembolization
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Management of Bleed from Percutaneous Portal Puncture Site (post-BRTO) by Trans-jugular-Trans-Hepatic Embolization

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