Persistent Encephalopathy in a Noncirrhotic Patient: Do not Shun This Shunt.

A portosystemic venous shunt is the formation of an abnormal connection between the portal vein and a systemic vein, allowing blood to bypass the liver. Portosystemic shunts are usually believed to be due to portal hypertension in the setting of underlying hepatic disease. We report a case of large, spontaneous intrahepatic portosystemic shunt in a noncirrhotic patient contributing to recurrent hepatic encephalopathy, also known as type B encephalopathy. Management of portosystemic encephalopathy involves occlusion of the shunt by endovascular management.