A Case of a Portal Hepatic Venous Shunt via an Intrahepatic Portal Vein Aneurysm Effectively Treated with Ligation of a Portal Vein Branch

Reiichiro Tanaka, Akira Kamasako, Shunsuke Kawamoto, Keita Miki, Ichiro Matano, Atsushi Murakami, Takashi Yamaguchi¹⁾, Masami Sato²⁾

Department of Surgery, National Mito Hospital
¹⁾Department of Gastroenterology, National Mito Hospital
²⁾
Depatment of Surgery, Takasu Hospital

Reports of a portal hepatic venous shunt (PHVS) via an intrahepatic portal vein aneurysm (IPVA) are extremely rare, though they have gradually increased with the development of the diagnostic imaging technology of today. We present a case of a PHVS via an IPVA effectively treated with ligation of a portal vein branch. A 71-year-old man with early gastric cancer (IIa, sm, tub₂, n₀ was admitted for an operation, and CT and MRI revealed a PHVS via an IPVA measuring 3×3×4 cm in the anterior lateral segment (S₃) of the left lobe of the liver. There was no ascites or esophageal varices, but there was splenomegaly. His laboratory data were: prothrombin time 100%; total serum bilirubin 1.2 mg/dl; HCV positive; white blood cell count 3100/mm₃; platelet count 11×10⁴/mm³; plasma ammonia 130 µg/dl; ICG15 47%. Although there are no abnormalities were found by electroencepharography, neurological examination revealed scanning speech and gait ataxia and other abnormalities. He had Child class A liver cirrhosis except such neurological symptoms. On 11/29/94 we performed ligaton of a portal vein branch P₃) and a partial gastrectomy and splenectomy. Portal vein pressure showed no change after the operation (16.5→16.4 cmH₂O). Laboratory data were improved after the operation: plasma ammonia 31 µg/dl; ICG 15 26%. Neurological symptoms were also improved significantly. Endoscopy has revealed no esophageal varices yet.

Key words
portosystemic encephalopathy, a portal hepatic venous shunt via an intrahepatic portal vein aneurysm, ligation of the left branch of portal vein

Reprint requests
Reiichiro Tanaka Department of Critical Care Medicine, Matsudo Municipal Hospital
4005 Kamihonngou, Matsudo, 217 JAPAN

Accepted
March 6, 1996

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