Hepatic Encephalopathy in Non-Cirrhotic Portal Hypertension: A Case Report

Abstract

Non-cirrhotic portal hypertension (NCPH) includes a group of diseases characterised by increased portal pressure without cirrhosis of the liver. It can result from primary hepatic conditions or systemic disorders affecting the liver. PSVD and chronic portal vein thrombosis (PVT) are the most common causes of NCPH. The natural course of NCPH is largely indolent and benign, with an overall better prognosis than cirrhosis, provided that complications of portal hypertension are properly managed and regular surveillance is maintained. Here, we report the unusual presentation of hepatic encephalopathy without liver cirrhosis in a 53-year-old Bangladeshi woman who presented with acute confusion and gradually worsening sleep disturbances. On examination, she had splenomegaly but no other peripheral stigmata of chronic liver disease. Investigations revealed preserved synthetic liver and metabolic function. Viral serology was negative. However, the complete blood count showed thrombocytopaenia, serum ammonia was grossly elevated; ultrasound showed a coarse, shrunken liver and a dilated portal vein. Upper GI endoscopy revealed a grade-II oesophageal varix. Transient elastography (Fibroscan) of the liver indicated portal fibrosis (F2) without septal involvement. The triphasic CT scan of the abdomen showed spontaneous portosystemic shunting, establishing the aetiology of the portal hypertension.

The final diagnosis was acute confusional state due to hepatic encephalopathy, with non-cirrhotic portal hypertension caused by PSVD. She was treated accordingly and discharged after three days.

This case demonstrates that hepatic encephalopathy can occur despite preserved hepatic synthetic function and absence of cirrhosis. Recognition of NCPH is crucial to avoid diagnostic delay and to ensure appropriate surveillance for complications of portal hypertension.

Bangladesh J Medicine  2026; Vol. 37, No. 2(1): pp.  242-243