Portosplenic blood flow separation in a patient with portosystemic encephalopathy and a spontaneous splenorenal shunt.
A patient with portosystemic encephalopathy, hyperammonemia, and a spontaneous splenorenal shunt was admitted to the authors' institution after a failed attempt at transvenous retrograde shunt obliteration. As an alternative approach, the authors separated splenic and portal flows by embolizing only the proximal splenic vein while leaving the shunt intact. Thus, the splenic flow could escape into the systemic circulation and an extreme increase in portal pressure was avoided. The procedure could provide rapid decreases in blood ammonia levels and a fast resolution of symptoms, but repeated interventions were required.
Department of Radiology, Hyogo Saiseikai Hospital, Kobe-shi, Hyogo-ken, Japan. armando@med.kobe-u.ac.jp
Carlos Armando
CA
Zamora
Koji
K
Sugimoto
Masakatsu
M
Tsurusaki
Masato
M
Yamaguchi
Kenta
K
Izaki
Takanori
T
Taniguchi
Yuki
Y
Iwama
Fumitoshi
F
Mimura
Kazuro
K
Sugimura
D004621:Embolization, Therapeutic; D006501:Hepatic Encephalopathy / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D022124:Hyperammonemia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D007668:Kidney / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery*; D008102:Liver Circulation; D008297:Male; D008642:Mesenteric Veins / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D011169:Portal Vein / Q000503:physiopathology / Q000601:surgery; D012039:Regional Blood Flow; D013154:Spleen / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery*; D013162:Splenic Vein / Q000503:physiopathology / Q000601:surgery; D014463:Ultrasonography