Transjugular intrahepatic portosystemic shunting in combined treatment of a patient with decompensated liver cirrhosis and malignant neoplasm of the uterus (clinical case)

Abstract

Nowadays the treatment of patients with malignant neoplasms of the abdominal organs against the background of decompensated liver cirrhosis is largely an unsolved problem. Complications of portal hypertension syndrome such as ascites, hypersplenism, recurrent bleeding from the veins of the esophagus prevent the implementation of radical surgical treatment. Low trauma of endovascular methods of treatment, low level of complications and mortality are the main advantages of interventional techniques that make it possible to prepare a patient with portal hypertension syndrome for further radical treatment of oncological disease. The presented clinical case describes the results of a combined approach to the treatment of a patient with complications of portal hypertension syndrome and a competing disease — a giant tumor of the uterus. The patient was denied in surgical treatment for the neoplasm due to the presence of decompensated cirrhosis. Liver transplantation is not possible due to the presence of cancer. Transjugular intrahepatic portosystemic shunting led to relief of diuretic-resistant ascites, regression of the degree of esophageal varicose veins, which made it possible to remove the tumor with extirpation of the uterus with appendages. Up to now the observation period for the patient is more than 12 years (4 figs, bibliography: 7 refs).

Keywords

ascites / esophageal varicose veins / portal hypertension syndrome / uterine rhabdomyosarcoma

References

[1] Guidelines for the screening, care and treatment of persons with hepatitis C infection. Geneva. World Health Organization; 2016. 138. Available at: https://apps.who.int/iris/bitstream/handle/10665/205035/9789241549615_eng.pdf?sequence=1 (accessed 15.10.2020).

[2] Prevention and control of viral hepatitis infection: framework for global action. Geneva: World Health Organization; 2012. 24. Available at: http://apps.who.int/iris/bitstream/10665/130012/1/WHO_HSE_PED_HIP_GHP_2012.1_eng.pdf?ua=1 (accessed 15.10.2020).

[3] Borisov A. E., Andreev G. N., Ibaldin A. S., Borisova N. A. Endovascular methods of diagnosis and treatment of portal hypertension. Almaty: Kartpredpriyatiye MSKH Publisher; 1996.104. Russian (Борисов А. Е., Андреев Г. Н., Ибальдин А. С., Борисова Н. А. Эндоваскулярные методы диагностики и лечения портальной гипертензии. Алматы: Картпредприятие МСХ; 1996. 104).

[4] Zubarev P. N. Development of the idea of surgical treatment of patients with portal hypertension at the Military Medical Academy: a speech on the day of the 202 anniversary of the Academy. Saint Petersburg: VMedA Publisher; 2000. 12. Russian (Зубарев П. Н. Развитие идеи хирургического лечения больных портальной гипертензией в Военно-медицинской академии: актовая речь в день 202-й годовщины Академии. СПб.: ВМедА; 2000. 12).

[5] Tripathi D., Stanley A. J., Hayes P. C., Travis S., Armstrong M. J., Tsochatzis E. A., Rowe I. A., Roslund N., Ireland H., Lomax M., Leithead J. A., Mehrzad H., Aspinall R. J., McDonagh J., Patch D. Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension. Gut. 2020; 69 (7): 1173–92.

[6] Patsiora M. D. Surgery of portal hypertension. 2nd ed., add. Tashkent: Meditsina Publisher; 1984. 319. Russian (Пациора М. Д. Хирургия портальной гипертензии. 2-е изд., доп. Ташкент: Медицина; 1984. 319).

[7] Strunk H., Marinova M. Transjugular Intrahepatic Portosystemic Shunt (TIPS): Pathophysiologic Basics, Actual Indications and Results with Review of the Literature. Fortschr. Röntgenstr. 2018; 190 (8): 701–11.

RIGHTS & PERMISSIONS

Alentyev S.A., Onnicev I.E., Berlev I., Muzharovskiy A.L.