2019 Volume 23 Issue 1 Pages 83-87
A 71-year-old male had replacement of the aortic root and ascending aorta for Stanford type A aortic dissection. After the operation, he had liver dysfunction, renal dysfunction, and delayed emergence. Even after liver and kidney function normalized, the delayed emergence continued. Enhanced CT showed a portosystemic shunt, which caused hyperammonemia and was associated with delayed emergence. After he was treated with a branched chain amino acid preparation and lactulose preparation, his consciousness level recovered.
Hepatic encephalopathy due to portosystemic shunt was reported in 1950 as Inose type hepatic encephalopathy, which is relatively rare. When hyperammonemia is prolonged postoperatively, it is necessary to confirm the presence or absence of portosystemic shunt.
