A Case of Spontaneous Giant Splenorenal Shunt with Situs Inversus

Yuji Nagai, Kazuhiko Yoshikawa, Yuzo Higashi, Yasuya Yamada, Yuichi Arimoto, Tetsuro Ishikawa, Hiroji Nishino, Takafumi Yamashita, Michio Sowa

First Department of Surgery, Osaka City University School of Medicine

There are few case reports of a portocaval shunt with situs inversus. Here we report on a 7l-year-old man with a splenorenal shunt and complete situs inversus. The patient had a gastrectomy for a benign gastric ulcer 6 years earlier. After gastrectomy, he was found to have developed liver dysfunction, and he received treatment for it. Recently he was admitted to our hospital because of hyperammonemia. His serum ammonia level rose to a maximum of 274 µg/dl. Although he had a tendency toward sleepness, there were no abnormal findings by EEG. Abdominal angiography and percutaneous transhepatic portography revealed a spontaneous giant splenorenal shunt (2.0 cm in diameter). Neither abdominal CT nor ultrasonography showed the spleen. The histological findings of a liver needle biopsy showed fibrosis of the liver. On diagnosis of the splenorenal shunt without liver cirrosis, the shunt was ligated. At that time, three small spleens were found near the pancreas tail. The postoperative portal vein pressure did not show any appreciable increase compared with the preoperative level (110 mmH₂O-125→ mmH₂O). The preoperative high level of serum ammonia decreased to the normal range after the operation.

Key words
situs inversus, portocaval shunt, polysplenia

Reprint requests
Yuji Nagai First Department of Surgery, Osaka City University School of Medicine
1-5-7 Asahi-cho, Abeno-ku, Osaka, 545 JAPAN

Accepted
November 11, 1992

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