A case of noncirrhotic hepatic encephalopathy due to porto-hepatic venous shunt successfully treated with percutaneous transhepatic obliteration

Abstract

A 68-year-old man was admitted to our hospital with disturbance of consciousness. He had no history of liver disease. Laboratory evaluation revealed an elevated serum ammonia of 176 μg/dl. Hyperammonemia was not improved by oral administration of Lactitol hydrate. Computed tomography and ultrasound examination demonstrated a shunt between the left portal vein and the left hepatic vein, for which percutaneous transhepatic obliteration to the portal-hepatic venous shunt was performed. Following the shunt embolization, hyperammonemia was improved.

Hepatic encephalopathy due to a portal-hepatic venous shunt is relatively rare. When a patient presents with hyperammonemia and no history of liver disease, it is necessary to explore for the presence of a portosystemic venous shunt.