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Editor’s quiz: GI snapshot
Massive gastrointestinal bleeding after transjugular intrahepatic portosystemic shunt (TIPS)
  1. Juan E Corral,
  2. Omar Y Mousa,
  3. Douglas L Riegert-Johnson
  1. Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
  1. Correspondence to Dr Juan E Corral, Department of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224; corral.juan{at}mayo.edu

https://doi.org/10.1136/gutjnl-2017-314254

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    Clinical presentation

    A patient with end-stage liver disease secondary to haemochromatosis was transferred to our hospital for variceal bleeding. During the previous 5 months, she underwent 10 oesophagogastroduodenoscopies (EGD) with repeated endoscopic band ligations (EBL). Following the most recent EBL, she was transferred to our hospital for emergent transjugular intrahepatic portosystemic shunt (TIPS) procedure. The patient arrived on mechanical ventilator support with continuous infusion of intravenous inotropes. After multiple blood transfusions and supportive measures, she had a successful TIPS procedure (mean portal-systemic gradient decreased from 11 mm Hg to 4 mm Hg). She recovered and was transferred to the general medical ward.

    Six days after the TIPS, she had another episode of hematochezia, …

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    Footnotes

    • Contributors JEC and OYM contributed to the conception and design; collection, analysis and interpretation of the data; generation of figures; and drafting the article. DLRJ contributed to the conception and design, analysis and interpretation of the data, and critical revision of the article. All authors approved the final article.

    • Competing interests None declared.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Provenance and peer review Not commissioned; externally peer reviewed.