Portal vein invasion and cavernous transformation secondary to hepatic echinococcosis successfully managed by TIPS: a case report and literature review.

BACKGROUND: Hydatid disease is a zoonotic parasitic disease caused by Echinococcus larvae, with hepatic echinococcosis sometimes exhibiting malignant-like behavior including vascular invasion. Portal vein invasion is a rare complication, and no prior report has described gastrointestinal hemorrhage due to portal hypertension from hydatid-induced portal vein invasion and cavernous transformation successfully treated by transjugular intrahepatic portosystemic shunt (TIPS). CASE PRESENTATION: A 44-year-old female with recurrent gastrointestinal bleeding and a history of right hepatectomy for hepatic alveolar echinococcosis was admitted. CT and ultrasound revealed portal vein invasion and cavernous transformation. TIPS was successfully performed, reducing the portosystemic pressure gradient from 22 mmHg to 9 mmHg. DISCUSSION: Hepatic echinococcosis may cause portal vein invasion and cavernous transformation. Medical therapy is poorly effective for severe complications like gastrointestinal hemorrhage. TIPS plays an important role in managing such patients. CONCLUSIONS: Portal hypertension-related complications are rare but challenging in echinococcosis treatment. TIPS is an effective option for patients with gastrointestinal bleeding, even in the setting of portal vein invasion and cavernous transformation.