Abstract
We present the case of a 68-year-old male hemodialysis patient who developed portal-systemic shunt encephalopathy. Hemodialysis was started owing to diabetic nephropathy in April 2000. He previously underwent partial gastrectomy for gastric ulcer and blood transfusion. Since September 2004, fecal incontinence, some cognitive symptoms, and depression have sometimes occurred. Although he had been a heavy drinker and was a hepatitis C virus carrier, abdominal echography and computed tomography (CT) did not indicate any evidence of liver cirrhosis, and laboratory examination findings were normal except for the serum ammonia level, which was elevated at 232μg/dL. Moreover, abdominal enhanced CT and angiography revealed a portal-systemic shunt from the splenic vein via the left testicular vein to the left renal vein. Despite treatment with a solution containing branched-chain amino acids (Aminoleban®), hyperammonemia did not improve. Balloon-occluded retrograde transvenous obliteration (B-RTO) was performed. The serum ammonia level was normalized and cognitive symptoms improved after the obliteration. During a 9-month follow-up period, there was no recurrence of encephalopathy.
