Portosystemic Shunt Following Gastrectomy-A Report of Two Cases

Abstract

We present two uncommon cases of a large portosystemic shunt under normal portal pressure. The patients (58-and 65-year-old men) developed disturbances of consciousness associated with electroencephalographic (EEG) abnormalities and severe hyperammonemia after a gastrectomy for peptic ulcer, 20 years and 31 years earlier, respectively. Neurological examinations and liver function tests were within normal limits except for the ICG. Large portosystemic shunts between the coronary gastric vein and the left renal vein were demonstrated by transarterial portography, and identified during the operation. The portal system was verified to be normotensive, 140 and 103 mm saline in each case, respectively, and histological examination of the liver revealed no parenchymal disease. Immediately after surgical removal of the shunts, the hyperammonemia and EEG abnormalities as well as disturbed consciousness returned to normal. Both the corkscrew apperance of the peripheral hepatic arteries and atrophy of the liver seen before the operation improved. ICG retention rates returned to almost normal values. We discuss the probability that the extraordinary portosystemic shunts were due to a local pressure rise in the coronary gastric vein following the previous gastrectomy. We present this bizarre syndrome as one of the postgastrectomy complications.