{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T06:56:52Z","timestamp":1790578612703,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"content-version":"vor","delay-in-days":269,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100011132","name":"Rutgers, The State University of New Jersey","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011132","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Gastrointestinal Medicine"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Refractory hyperammonemic encephalopathy in cirrhosis presents a therapeutic challenge, particularly in post\u2010TIPS patients or with contraindications to standard therapies. We report a fatal case complicated by small bowel obstruction (SBO), highlighting the limitations of current management strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 69\u2010year\u2010old male with decompensated NASH cirrhosis and recent TIPS revision for shunt stenosis developed SBO. He presented with severe encephalopathy (GCS 5), seizures, and MRI\u2010confirmed cerebral edema. Due to SBO, lactulose and rifaximin were not effective. Despite aggressive dialysis with continuous venovenous hemodialysis (CVVHD) reducing ammonia from 447 to 160\u2009\u03bcmol\/L, he progressed to irreversible cerebral edema and met brain death criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Post\u2010TIPS hyperammonemia carries high mortality, especially when compounded by SBO. CVVHD effectively lowers ammonia but may fail to prevent neurologic injury if initiated late.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case underscores the need for proactive RRT and novel ammonia\u2010lowering strategies in high\u2010risk patients, especially when gut decontamination is not feasible.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/crgm\/3799217","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T06:28:47Z","timestamp":1790576927000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Refractory Post\u2010TIPS Hepatic Encephalopathy Complicated by Small Bowel Obstruction: A Therapeutic Dilemma"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9959-3470","authenticated-orcid":false,"given":"Ammar","family":"Ismail","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3496-6460","authenticated-orcid":false,"given":"Amira","family":"Alnakeb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saba","family":"Altarawneh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Depasquale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,27]]},"reference":[{"key":"e_1_2_11_1_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.24616"},{"key":"e_1_2_11_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0168-8278(01)00129-5"},{"key":"e_1_2_11_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510300316"},{"key":"e_1_2_11_4_2","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1002\/hep.510280508","article-title":"Portosystemic Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt in Patients With Cirrhosis","volume":"28","author":"Nolte W.","year":"1998","journal-title":"Hepatology"},{"key":"e_1_2_11_5_2","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1002\/hep.27210","article-title":"Hepatic Encephalopathy in Chronic Liver Disease: 2014 Practice Guideline by AASLD and EASL","volume":"60","author":"Vilstrup H.","year":"2014","journal-title":"Hepatology"},{"key":"e_1_2_11_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/nejmra1208937"},{"key":"e_1_2_11_7_2","doi-asserted-by":"publisher","DOI":"10.2215\/cjn.01320216"},{"key":"e_1_2_11_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/liv.12221"},{"key":"e_1_2_11_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/bf01320309"},{"key":"e_1_2_11_10_2","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1136\/bmj.282.6260.263","article-title":"A 20-Year Prospective Study of Cirrhosis","volume":"282","author":"Saunders J. 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