title: Recurrent hepatic pre-coma resulting from a spontaneous porto-spleno-renal shunt (PSRS).
abstract: A 64-year-old Turkish male is described with recurrent hepatitic (pre-)coma resulting from a spontaneous porto-spleno-renal shunt, portal hypertension and hepatic insufficiency. In cases of chronic encephalopathy resulting from hepatic insufficiency that may be due to liver cirrhosis, the presence of a spontaneous porto-spleno-renal shunt should be considered as a distinct possibility, not only in the absence of apparent oesophageal varices and splenomegaly, but also when there is hepatopetal flow in the portal vein.
authors.affiliation: Department of Internal Medicine, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Overdorp
authors.forename: H S
authors.initials: HS
authors.lastname: Tan
authors.forename: A H
authors.initials: AH
authors.lastname: Molenaar
authors.forename: J B
authors.initials: JB
authors.lastname: Janssen
mesh_terms: D005402:Fistula / Q000150:complications* / Q000000981:diagnostic imaging; D006471:Gastrointestinal Hemorrhage; D006501:Hepatic Encephalopathy / Q000209:etiology*; D006503:Hepatic Veins / Q000503:physiopathology*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011859:Radiography; D013162:Splenic Vein / Q000503:physiopathology*