Abstract
Two patients with giant spontaneous splenorenal shunts are presented. Case 1. A 34-year-old man spontaneously developed a giant splenorenal shunt. Small esophageal varices were present, and mentation was normal. Because the serum anmonia concentration was elvated, we constructed a selective splenorenal shunt with splenopancreatic and gastric disconnection to decrease shunt flow and prevent enlargement of the varices. Case 2. A 27-year-old man was noted to have small esophageal varices without any elevation of the serum anmonia concentration. We constructed a splenorenal shunt using a spontaneous splenorenal shunt with spleno-gastric disconnection to prevent subsequent development of hepatic encephalopathy. Patients with a giant spontaneous splenorenal shunt are at risk of progressive hepatic encephalopathy and liver dysfunction secondary to reduced portal vein flow. To prevent this, it is necessary to divert the shunt flow; a selective splenorenal shunt with pancreatic gastric disonnection should be constructed to prevent enlargement of esophageal varices.
