Direct Intrahepatic Portocaval Shunt for Sinusoidal Obstruction Syndrome Associated with Hepatotoxicity of Pyrrolizidine Alkaloids

Figure 1

DIPS placement combined with IVC stenting in SOS. A female patient, aged 44 years, presented with botanical hepatotoxicity of pyrrolizidine-alkaloid-related decompensated cirrhosis. (a–c) CT shows liver enlargement, thinning portal vein, narrowed hepatic segment of IVC, presence of ascites, outflow obstruction of hepatic vein, and patchy signal enhancement in the absence of hepatic vein occlusion. (d) Specimen obtained from percutaneous transhepatic biopsy before treatment. High power image (100×, hematoxylin–eosin staining) showing dilatation of sinusoids and necrosis of hepatocytes (long arrow). Terminal hepatic vein was occluded (short arrow), but collagen deposition had not yet occurred. (e) IVC stenosis (black arrow). (f, g) After stent implantation of IVC, the intrahepatic left portal vein was punctured through the IVC stent. (h,i) DIPS stent implantation (black arrow indicates spring coil in the left gastric vein after embolization; venography shows that the variceal collateral vessel was not manifested).

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