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Case Reports
. 2020 Apr 15;59(8):1047-1051.
doi: 10.2169/internalmedicine.3955-19. Epub 2020 Feb 1.

Intractable Hepatic Encephalopathy with a Large Portosystemic Shunt Successfully Treated Using Shunt-preserving Disconnection of the Portal and Systemic Circulation

Masafumi Haraguchi  1 , Satoshi Hirai  1 , Yutaka Nakamura  1 , Tetsuhiro Otsuka  2 , Hideki Ishimaru  2 , Ryu Sasaki  1 , Masanori Fukushima  1 , Satoshi Miuma  1 , Hisamitsu Miyaaki  1 , Kazuhiko Nakao  1
Affiliations
Case Reports

Intractable Hepatic Encephalopathy with a Large Portosystemic Shunt Successfully Treated Using Shunt-preserving Disconnection of the Portal and Systemic Circulation

Masafumi Haraguchi et al. Intern Med. .

Abstract

Hepatic encephalopathy (HE) is a significant symptom of decompensated liver cirrhosis. Occlusion of portosystemic shunts is used to treat refractory HE. Nevertheless, these treatments often cause adverse events, such as ascites and esophageal varices. We treated a 57-year-old man with refractory HE using shunt-preserving disconnection of the portal and systemic circulation (SPDPS). After SPDPS, there were no obvious complications, and the patient's ammonia level significantly decreased. To date, the patient has not experienced recurrent HE. SPDPS appears to be a safe and effective treatment method for portosystemic encephalopathy.

Keywords: hepatic encephalopathy; percutaneous transsplenic access; shunt-preserving disconnection of the portal and systemic circulation.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
(a) Three-phase contrast-enhanced computed tomography (CT) in the late phase showing huge portosystemic shunt (arrowhead). (b) 3D-CT showing huge portosystemic shunt (blue: porto-systemic shunt; brown: portal vein; red: superior mesenteric vein).
Figure 2.
Figure 2.
(a) Before embolization, splenic venography reveals the portal vein (red arrowhead) and huge portosystemic shunt (white arrowhead). (b) After coil embolization (arrow), splenic venography reveals only a large portosystemic shunt (white arrowhead), without the portal vein. (c) A schematic illustration of the hemodynamics after selective embolization of the splenic vein for shunt-preserving disconnection of the portal and systemic circulation. Arrows show the direction of blood flow in the splenic vein and superior mesenteric vein.
Figure 3.
Figure 3.
(a) The ammonia levels before and after shunt-preserving disconnection of the portal and systemic circulation (arrowhead). The ammonia levels significantly declined following the procedure. (b) The albumin and platelet levels after shunt-preserving disconnection of the portal and systemic circulation (arrowhead). The albumin and platelet levels improved for approximately 2 months.
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