Abstract
Portosystemic encephalopathy is often overlooked, being treated as a decrease in cognitive function in elderly patients. We herein report a case of traumatic splenic rupture with a portosystemic shunt. We resected the spleen and resolved the occlusion of the portosystemic shunt via intraoperative ultrasound. An 84-year-old woman was transported to the emergency room with loss of consciousness. She had fallen and fractured a rib 11 days earlier. Emergency splenic resection was performed following a diagnosis of late-onset splenic rupture and intra-abdominal bleeding. Before the surgery, we confirmed the splenic renal shunt and diagnosed her with portosystemic encephalopathy. We confirmed portal reflux in the left branch of the portal vein with intraoperative ultrasonography. The splenic renal shunt was ligated due to antegrade portal blood flow when the shunt became occluded. Because of the emergent nature of the surgery, preoperative inspections were inadequate. We carefully evaluated whether or not we could resolve the occlusion of the splenic renal shunt via intraoperative ultrasound. After surgery, the portal vein blood flow remained antegrade, and her level of consciousness rapidly improved. Emergency occlusion of the portosystemic shunt was therefore deemed effective. Because intraoperative ultrasound can be used to monitor the blood flow in real time, we successfully resolved the occlusion of the splenic renal shunt effectively and safely. We therefore considered that intraoperative ultrasonography was useful.
