Abstract
A 73–year–old woman previously diagnosed with symptomatic epilepsy and vascular. Dementia was brought to the hospital by ambulance for atypical unconsciousness. She was found in laboratory studies to have elevated serum ammonia of 472 μg/dl and in computed tomography (CT) to have a portosystemic shunt between the inferior mesenteric and left ovarian veins, yielding a diagnosis of Inose hepatic encephalopathy. When her serum ammonia level had not normalized after medical therapy, she underwent interventional radiology (IVR), which did not completely occlude, the shunt so shunt vessels were resected, after which serum ammonia level and hepatic encephalopathy both improved. IVR is now first–line treatment for portosystemic shunt, but shunt–vessel resection is effective if the shunt is not completely occluded by IVR.
