An Unexpected Favourable Evolution of Advanced Stage Cirrhosis

  • Tiago Rabadão Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Leonor Naia Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Filipa Ferreira Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Mariana Teixeira Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Marcelo Aveiro Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Margarida Eulálio Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Susana Calretas Adult Liver Transplant Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

Keywords

ecompensated cirrhosis, alcohol abstinence, portal vein thrombosis, refractory ascites, transjugular intrahepatic portosystemic shunt (TIPS)

Abstract

The elimination of the aetiological factors causing liver injury is an important cornerstone in preventing progression and increasing survival in patients with cirrhosis. The authors present the case of a 63-year-old woman with a history of long-term alcohol abuse and consequent liver cirrhosis. Over the years, the patient presented progressive deterioration with severe malnutrition and had multiple hospital admissions due to decompensated cirrhosis, including refractory ascites, variceal bleeding and an extensive portal vein thrombosis (PVT). Anticoagulant therapy was not initiated due to a high risk of variceal bleeding. She eventually became abstinent, but PVT precluded a liver transplant. Over the following 10 years, her performance status gradually improved, with no new decompensation episodes and liver function normalization, although refractory ascites persisted. Abdominal CT showed spontaneous recanalization of the portal vein and a transjugular intrahepatic portosystemic shunt (TIPS) procedure was performed with gradual improvement of ascites. In this atypical case, an unexpected favourable evolution of advanced stage cirrhosis was observed with long-term improvement in clinical status and liver function, resulting in an estimated 10-year cumulative mortality rate of 99.98% and highlighting the importance of abstinence. Unexpectedly, spontaneous complete repermeabilization of the PVT was also observed, despite its extent and the absence of anticoagulation therapy.

VIEW THE ENTIRE ARTICLE

References

Zhou W, Zhang Q, Qiao L. Pathogenesis of liver cirrhosis. World J Gastroenterol 2014;20(23):7312–7324.

D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 2006;44217–231.

European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of decompensated cirrhosis. J Hepatol 2018; https://doi.org/10.1016/j.jhep.2018.03.024.

European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Vascular diseases of the liver. J Hepatol 2016;64:179–202.

Faccia M, Ainora ME, Ponziani FR, Riccardi L, Garcovich M, Gasbarrini A, et al. Portal vein thrombosis in cirrhosis: why a well-known complication is still matter of debate. World J Gastroenterol 2019;25(31):4437–4451.

Published: 2020-12-03

Issue: Vol 8 No 1 (view)

Section: Articles

How to cite:
1.
Rabadão T, Naia L, Ferreira F, Teixeira M, Aveiro M, Eulálio M, Calretas S. An Unexpected Favourable Evolution of Advanced Stage Cirrhosis. EJCRIM 2020;8 doi:10.12890/2020_002122.

Most read articles by the same author(s)