A case of the peculiar portosystemic shunt unsuccessfully managed with Partial Splenic artery Embolization, Percutaneous Transhepatic Obliteration and ligation of paraumbilical vein

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  • 部分的脾動脈塞栓術，経皮経肝的シャント塞栓術と外科的傍臍静脈結紮術が不成功に終わった特異な門脈大循環シャントの１例
  • 症例報告 部分的脾動脈塞栓術,経皮経肝的シャント塞栓術と外科的傍臍静脈結紮術が不成功に終わった特異な門脈大循環シャントの1例
  • ショウレイ ホウコク ブブンテキヒドウミャク ソクセンジュツ ケイヒケイ カンテキ シャント ソクセンジュツ ト ゲカテキ ボウセイジョウミャク ケッサツジュツ ガ フセイコウ ニ オワッタ トクイ ナ モン ミャク ダイ ジュンカン シャント ノ 1レイ

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Abstract

We experienced a case of the intractable portosystemic shunt after repeated endoscopic variceal ligation for esophageal varices. A 48 years-old woman was observed for cryptogenic liver cirrhosis by nearby hospital since 2001. There was a past history of esophageal varices, for which she was underwent endoscopic variceal ligation, and she was hospitalized with hepatic encephalopathy at the nearby hospital repeatedly. She was referred to our hospital for gastric varices (F2, RC (-)). Abdominal angiography showed the peculiar portosystemic shunts through left gastric vein and paraumbilical vein. We intended to treat repeated hepatic encephalopathy due to these portosystemic shunts. After partial splenic aretery embolization for portalhypertension, we performed percutaneous transhepatic obliteration for left gastric vein and surgical ligation of paraumbilical vein under general anesthesia. However, we recognized newly portosystemic shunt through posterior gastric vein after surgery, and there was little change in serum ammonia level. This case was instructive for making decision of the treatment of portosystemic shunt with hepatic encephalopathy.<br>

Journal

  • Kanzo

    Kanzo 47 (9), 441-447, 2006

    The Japan Society of Hepatology

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