A Case of Interventional Radiology Effective for Portosystemic Encephalopathy with a Large Splenorenal Shunt

Tetsuya Kaneko, Akio Harada, Norimasa Yoshida, Soichiro Inoue, Hiroya Murakami, Toshiaki Nonami, Akimasa Nakao, Hiroshi Takagi

Department of Surgery II, Faculty of Medicine, Nagoya University

A 57-year-old woman hospitalized for recurrent loss of consciousness. A giant splenorenal shunt was suspected from color doppler ultrasonography. Percutaneous transhepatic portography and selective injection of contrast medium into the shunt clearly visualized the whole aspect of the splenorenal shunt. When she lost consciousness, her blood ammonia level was 326µg/dl. The results of serum amino acid analysis revealed a high level of aromatic amino acids and a low Fisher's ratio. Indocyanine green (ICG) clearance from blood was very low. Perfect embolization of the giant splenorenal shunt was performed by ultrasound-guided interventional radiology, after which the blood levels of ammonia and aromatic amino acids normalized. Fisher's ratio and ICG clearance were improved ten months after this procedure, the patient is well and has not experienced any loss of consciousness. For the portosystemic encephalopathy accompanying severe liver damage, shunt embolization by interventional radiology was effective and less invasive than surgical operation.

Key words
portosystemic shunt encephalopathy, splenorenal shunt, percutaneous transhepatic embolization

Reprint requests
Tetsuya Kaneko Department of Surgery II, Faculty of Medicine, Nagoya University
65 Tsurumai-cho, Showa-ku, Nagoya, 466 JAPAN

Accepted
April 13, 1994

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