Liver transplantation is safer, more readily available and is increasingly being carried out in younger patients. Therapeutic bridging procedures such as transjugular intrahepatic portosystemic shunt have therefore become more relevant to paediatrics, especially in the group of patients who are too unstable for surgery or in whom a liver graft is not available. We describe a transjugular intrahepatic portosystemic shunt procedure in a 4-year-old child with life-threatening variceal bleeding in whom the conventional procedure had failed. This technique may provide an alternative to conventional transjugular intrahepatic portosystemic shunt in this group.