Successful Surgical Treatment for Inose-type Hepatic Encephalopathy caused by the Porto-systemic Shunt Via Superior Mesenteric Varices: A Case Report

Takashi Mizuno, Saiho Ko, Toyoki Kobayashi, Hideki Kanokogi and Yoshiyuki Nakajima

First Department of Surgery, Nara Medical University

A 78-year-old woman with chronic hepatitis type B who had often gone into a coma of unknown origin since August 1986 was examined in 1999 and found to have high blood NH₃->200μg/dl-and superior mesenteric varices with a diameter of 2 cm. Portal phase of mesenteric arteriography showed a massive portosystemic shunt from the ileocecal vein to the vena cava via the varices. She was diagnosed with Inose hepatic encephalopathy and underwent surgery to close the shunt. After confirming that portal venous pressure was less than 180 mmH₂O by test clamping of the shunt, varices were resected. Pulsed Doppler ultrasonography showed a significant increase in portal blood inflow to the liver and blood NH₃ decreased to 50μg/dl immediately after surgery. Her encephalopathy disappeared completely and she remains healthy with improved liver functional reserve to date.

Key words
superior mesentric varices, porto-systemic shunt, hepatic encephalopathy

Reprint requests
Takashi Mizuno First Department of Surgery, Nara Medical University 840 Shijo-cho, Kashihara, 634-0313 JAPAN

Accepted
October 31, 2001

To read the PDF file you will need Abobe Reader installed on your computer.