Abstract
A 47-year-old man had frequent episodes of Inose-type hepatic encephalopathy due to large porto-systemic shunt from the splenic vein to the right common iliac vein via the inferior mesenteric vein. Coiling occlusion by interventional radiology (IVR) technique was attempted at another hospital, but was unsuccessful because the diameter of the shunt vessel was too large. He admitted to our hospital for surgical closure of shunt vessel. Intraoperative direct portography of the branch of the jejunal vein revealed that all mesenteric blood flew out into the large shunt vessel. Intrahepatic portal flow was absent. Before manipulation, portal venous pressure was 8 mmHg. When the shunt was clamped, recovery of hepatopetal portal blood flow was observed on portography and Doppler US. The portal venous pressure increased to 12 mmHg. Complete closure of the shunt vessel was then performed. The blood ammonia level was normalized on the day after surgery and recovery was uneventful. He has had no episodes of encephalopathy for 8 months after surgery. Surgical closure is an option that is effective for large porto-systemic shunts which cannot be closed by IVR.
