Abstract
A 54-year-old man with chronic hepatitis C was admitted to our hospital because of a disturbance of consciousness and hyperammonemia. Abdominal angiography revealed a portosystemic shunt between the superior mesenteric vein and inferior vena cava. Endoscopic examination showed no varix. As interventional treatment was unsuccessful, surgical ligation of the shunt was performed. After surgery, portography revealed a huge shunt. Before ligation, the portal pressure, portal flow speed, and volume at the umbilical portion were 24 H2O. 5.6 cm/s and 203 ml/min, respectively. Finally the shunt was ligated. The portal flow speed and volume increased for 14 days following surgery and then stabilized. No varices were observed postoperatively. Doppler ultrasound, portography, and portal pressure monitoring can be used to reveal haemodynamic changes in the portal system and justify surgical ligation of portosystemic shunt.
Highlights
Hepatic encephalopathy is one of the major complications observed in patients with liver cirrhosis.This encephalopathy is divided into two types: acute and chronic
Uflacker et al [6] reported the results of interventional treatment for a portosystemic shunt in five cases
Four of the five patients had permanent control of encephalopathy, hemodynamic problems including ascites, esophageal varix, and intraperitoneal bleeding were worse after this procedure
Summary
Hepatic encephalopathy is one of the major complications observed in patients with liver cirrhosis. This encephalopathy is divided into two types: acute and chronic. A 54-year-old man was admitted to our medical center because of a disturbance of consciousness and hyperammonemia He had had chronic hepatitis C infection for 10 years and had stuffed from nephropathy and retinopathy caused by diabetes mellitus for 20 years. On admission, his blood chemistry showed elevated levels of serum ammonia (416 μg/mL, normal range: 30–86), creatinine (4.8 mg/dL, normal range: 0.6–1.1), BUN (85 mg/dL, normal range: 7–21), and blood sugar (132 mg/dL, normal range: 55–110). A catheter was inserted into the distal superior mesenteric vein
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