A 49-year-old male cirrhotic enolic patient associated with Child stage B7 HCV infection was admitted due to altered level of consciousness. Ammonium levels remained persistently elevated during admission. An abdominal ultrasound scan showed a very dilated and tortuous peripancreatic collateral vessel, heterogeneous liver parenchyma without space-occupying lesions and a homogeneous 15 cm splenomegaly. Subsequently, an angio-CT scan was performed, which showed abundant collateral circulation associated with a spleno-renal portosystemic shunt.

Using interventional radiology techniques, the shunt was partially embolised with microcoils. Post-embolisation abdominal ultrasound showed the disappearance of the spleno-renal shunt. After embolisation, the patient showed rapid clinical improvement (disappearance of somnolence) and analytical improvement (normalisation of ammonium levels). He did not develop gastro-oesophageal varices or ascites. He did not require hospital admission during the 10 months of follow-up.

