Acute oesophageal variceal bleeding and portal vein thrombosis as complication after TIPSS. An unusual emergency indication for liver transplantation

Acute oesophageal variceal bleeding is a severe complication of portal hypertension caused by liver cirrhosis. The mortality of the first bleeding runs up to 50 %. Recurrent bleeding deteriorates the long-term prognosis. The therapy of first choice for acute oesophageal haemorrhage is endoscopic sclerotherapy. A new option to decompress portal hypertension for patients who continue to bleed despite sclerotherapy is TIPSS-implantation. We report on a patient suffering from recurrent oesophageal haemorrhage caused by portal hypertension due to postalcoholic liver cirrhosis, who developed a portal vein thrombosis after TIPSS-implantation. TIPSS-procedure permitted a bridging period for five months, until eventually a severe uncontrollable oesophageal haemorrhage occurred and emergency liver transplantation was needed. The patient was discharged after 6 weeks from the hospital in excellent condition.