Vol. 36 No. 2 (2026)

This November 2026 issue presents a case report by Ramar and colleagues from Chennai, India, on type II Abernethy malformation associated with hepatopulmonary syndrome and hyperammonemia in a 12-year-old girl. CT angiography demonstrated a congenital communication between the superior mesenteric vein and the infrarenal inferior vena cava, with patent intrahepatic portal branches.

The report describes cross-sectional vascular mapping, temporary balloon occlusion with assessment of portal filling and pressure, and single-stage endovascular closure using a vascular plug with adjunctive embolisation of collateral vessels. Oxygenation and serum ammonia improved during the three-month follow-up, although ammonia remained above the reference range.

The case highlights the role of anatomical and haemodynamic assessment when planning shunt closure. The unresolved baseline SpO₂/PaO₂ discrepancy, incomplete documentation of the anticoagulant dosing rationale and short follow-up limit interpretation; the findings do not establish long-term outcomes or a universal treatment protocol.