A Case of Spontaneous Encephalopathy Due to the Giant Shunt from Superior Mesenteric Vein to Inferior Vena Cava, Healed by Resection of the Shunt Vessels

Noritaka Maniwa, Seiji Marubayashi, Hiroshi Yahata, Yasuhiko Fukuda, Toshimasa Asahara, Yukihiko Dohi

The Second Department of Surgery, Hiroshima University of Medicine

A spontaneous hepatic encephalopathy due to a rare giant porto-systemic shunt was successfully treated by resection of the shunt. The patient was a 55 year-old male with liver cirrhosis and splenomegaly. Laboratory data were total bilirubin 2.6 mg/dl, ICGR₁₅ 44.5%, white blood cells 1800 and platelets 62000. A shunt vein with a diameter of 3.4 cm ran through the retro-peritoneal cavity from the superior mesenteric vein to the point just below the renal vein of the inferior vena cava. Shunt resection and splenectomy were performed. The portal pressure level was stable during the operation and the portal blood flow become hepato-fugal after the operation. White blood cells and platelets increased and the data on NH₃, ICG, bile acid and endotoxin were improved after the operation. Portal thrombosis developed after the operation but anti-coagulant therapy was effective. Peri-gastric devascularization was not performed but esophageal varix was not progressive. For the treatment of porto-systemic shunt resection is available but caution must be exercised for liver cirrhosis, esophageal varix and portal thrombosis.

Key words
spontaneous hepatic encephalopaty, porto-systemic shunt, portal thrombosis

Reprint requests
Noritaka Maniwa Department of Surgery, Otaka Natioanl Hospital
4-1-1 Kuba, Otake, 739-06 JAPAN

Accepted
November 8, 1989

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