Multiple visceral artery aneurysms and type II Abernethy malformation in a patient with autoimmune hepatitis

A man in his late 30s with Down syndrome (DS) and a background of cirrhosis secondary to autoimmune hepatitis (AIH) presented with a 2-week history of worsening confusion despite reported adherence to lactulose and rifaximin. He was non-verbal at baseline with moderate intellectual disability, making symptom elicitation dependent on collateral history from family and carers. His sister reported increased lethargy, inability to follow commands and episodes of vomiting. He had a Child-Pugh score of B9 and a Model for End-Stage Liver Disease-Sodium score of 11.