title: Surgical treatment for an extrahepatic portosystemic shunt: a case report.
abstract: An extrahepatic portosystemic shunt that has neither liver cirrhosis nor portal hypertension is rare. A 60-year-old Japanese woman who had been suffering chronic liver disease and anemia with mild disorientation was admitted to investigate general fatigue with dizziness and disorientation. The laboratory data revealed mild pancytopenia and liver dysfunction including hyperammoniemia, an increased Indocyanine Green 15-min retention rate, and a decreased Fischer's ratio. Color Doppler ultrasonography, computed tomography, and arterial portography revealed an extrahepatic portosystemic shunt that extended tortuously from the superior mesenteric vein into the inferior vena cava, and decreased blood flow in the main portal vein. Judging from intraoperative measurement of portal pressure and intraoperative portography, shunt ligations were performed at both the efferent portion of shunt from the superior mesenteric vein and the afferent portion of the shunt into the inferior vena cava, and resection of the spleen was also performed. On the postoperative laboratory data, pancytopenia disappeared, and liver function improved. Postoperative abdominal imaging showed increased blood flow in the main portal vein and disappearance of the shunt vessel. Moreover, symptoms present before surgery also disappeared. In conclusion, surgical treatment of extrahepatic portosystemic shunts may result in better postoperative quality of life if it is performed in carefully selected patients.
authors.affiliation: Department of Surgery, Wakayama Rosai Hospital, Wakayama, Japan. hotta@naxnet.or.jp
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Hotta
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Taniguchi
authors.forename: Kiyofumi
authors.initials: K
authors.lastname: Johata
authors.forename: Masaki
authors.initials: M
authors.lastname: Sahara
authors.forename: Takashi
authors.initials: T
authors.lastname: Watanabe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tanimura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Minakata
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Tsunoi
authors.forename: Yukari T
authors.initials: YT
authors.lastname: Tsubota
mesh_terms: D002908:Chronic Disease; D005260:Female; D006801:Humans; D022124:Hyperammonemia / Q000209:etiology; D008026:Ligation; D008107:Liver Diseases / Q000209:etiology; D008642:Mesenteric Veins / Q000002:abnormalities; D008875:Middle Aged; D010198:Pancytopenia / Q000209:etiology; D011168:Portal System / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D011172:Portography; D011184:Postoperative Period; D011300:Preoperative Care; D013154:Spleen / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014682:Vena Cava, Inferior / Q000002:abnormalities