A Case Report of Early Gastric Carcinoma Associated with Porta-systemic Encephalopathy

Kiyoshi Suzumura, Akihiro Yamaguchi, Masatoshi Isogai, Yuuji Kaneoka, Yoshihito Takahashi, Masahide Ri and Gen Sugawara

Department of Surgery, Ogaki Municipal Hospital

We report a rare case of a large left gastric-renal shunt in a 70-year-old woman with hepatic encephalopathy but no cirrhosis. She was admitted to our department because of hepatic coma. The serum ammonia level was elevated to 199μg/dl. A large abnormal vessel in the area of the stomach was discovered by ultrasonography during a screening examination for liver cirrhosis. Angiography revealed that the vessel was a large left gastric-renal shunt by the venous phase of superior mesenteric artery. Coincidentally, an early gastric carcinoma was discovered by gastrointestinal fiberscopy performed for screening of esophageal varices. During the operation for gastric carcinoma, the shunting vessel was clamped temporarily and then the portal vein pressure was slightly elevated from 16∼17mmHg to 17∼18mmHg. As ligation of the shunting vessel was considered safe, it was ligated and distal gastrectomy was performed in the usual manner. The postoperative hepatic function returned to normal and the serum ammonia level was reduced. In conclusion, case of hepatic encephalopathy but no hepatic parenchymal disorder of liver with a large shunting vessel, the vessel can be ligated safely.

Key words
porta-systemic shunt, hepatic encephalopathy

Reprint requests
Kiyoshi Suzumura Department of Surgery, Ogaki Municipal Hospital 4-86 Minaminokawa-cho, Ogaki-city, 503-0864 JAPAN

Accepted
January 26, 2000

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