A Case Report of Rectal Carcinoma Associated with Portosystemic Encephalopathy

Makoto Shimomura, Tsutomu Sekoguchi, Koji Fujii, Masato Kitagawa, Kikuhiro Nakamura, Toshio Yamamoto

Department of Surgery, Ise Municipal Hospital

The patient was a 68-year-old man with rectal carcinoma admitted to our service because of hepatic coma. On admission, the blood ammonia level was l9l µg/dl. The venous phase of a superior mesenteric and celiac angiogram showed a dilated, tortuous collateral vein, 2 cm in diameter, extending from the superior mesenteric vein to the inferior vena cava, with the contrast medium draining into the inferior vena cava through it. The portal vein was not visualized. After occlusion of the collateral vein by a balloon, the contrast medium drained to the liver through the portal vein and the wedge pressure of the hepatic vein rose from 17 mmHg to 20 mmHg. Ligation of the collateral vein and abdominoperineal resection was performed with a diagnosis of rectal carcinoma with portosystemic encephalopathy. Intraoperative manometry of the portal vein showed a 33% rise in pressure after ligation of the collateral vein. Postoperatively, the encephalopathy resolved without varix formation in the esophagus or stomach during the year of follow-up to date. The blood ammonia level has decreased, and liver function has improved. Because it is capable of both improving the portosystemic encephalopathy and improving liver function, obliteration of the portosystemic shunt appeared to be a meaningful method of treatment that should be aggressive performed.

Key words
portosystemic encephalopathy, liver function, rectal carcinoma

Reprint requests
Makoto Shimomura Department of Surgery, Ise Municipal Hospital
3038 Kusube-cho, Iseshi, 516-0014 JAPAN

Accepted
September 16, 1998

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