A case of successful surgical treatment for intra-and extrahepatic portosystemic venous shunt

Abstract

A 75-year-old-woman was referred to our hospital because of hepatic encephalopathy and hyperammonemia (258μg/dl) due to an intrahepatic portosystemic venous shunt (PSVS). Enhanced abdominal computed tomography, 3-dimensional reconstructed images, and arterial portography revealed two PSVSs in the hepatic anterior segment, as well as an extrahepatic PSVS between the veins originating from the ascending colon and inferior vena cava. During the preoperative examination, the patient developed septicemia due to urinary tract infection caused by Klebsiella species. After treatment with endotoxin-absorption and continuous hemodialysis-filtration, a hepatic anterior segmentectomy and ligation of the extrahepatic PSVS were performed. The liver parenchyma was normal on histology. The postoperative course was uneventful and the patient's consciousness level normalized, although her serum ammonia level fluctuated between 60 and 120 μg/dl. In the patients with intrahepatic PSVS, the presence of extrahepatic PSVS should be considered.