1990 Volume 23 Issue 3 Pages 777-781
A spontaneous hepatic encephalopathy due to a rare giant porto-systemic shunt was successfully treated by resection of the shunt. The patient was a 55 year-old male with liver cirrhosis and splenomegaly. Laboratory data were total bilirubin 2.6mg/dl, ICGR1544.5%, white blood cells 1800 and platelets 62000. A shunt vein with a diameter of 3.4 cm ran through the retro-peritoneal cavity from the superior mesenteric vein to the point just below the renal vein of the inferior vena cava. Shunt resection and splenectomy were performed. The portal pressure level was stable during the operation and the portal blood flow become hepato-fugal after the operation. White blood cells and platelets increased and the data on NH3, ICG, bile acid and endotoxin were improved after the operation. Portal thrombosis developed after the operation but anticoagulant therapy was effective. Peri-gastric devascularization was not performed but esophageal varix was not progressive. For the treatment of porto-systemic shunt resection is available but caution must be exercised for liver cirrhosis, esophageal varix and portal thrombosis.
