title: Non-cirrhotic portal-systemic encephalopathy caused by enlargement of a splenorenal shunt after pancreaticoduodenectomy for locally advanced duodenal cancer: report of a case.
abstract: We report a case of portal-systemic encephalopathy occurring secondary to a splenorenal shunt, 2 years after a pancreaticoduodenectomy for locally advanced duodenal carcinoma. A 55-year-old woman was brought to our hospital with a decreased level of consciousness. Laboratory testing revealed an elevated serum ammonia level (221 μg/dl) and normal liver function. Retrospective review of a series of contrast-enhanced computed tomography scans of the abdomen identified a splenorenal shunt, which had gradually enlarged over the past 2 years (Fig. 1). The decreased level of consciousness was thought to be due to portal-systemic encephalopathy secondary to the splenorenal shunt. We performed balloon-occluded retrograde transvenous obliteration to occlude the splenorenal shunt, following which her serum ammonia level returned to normal (28 μg/dl) and an alert level of consciousness was maintained.
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan, nanka_u_t@yahoo.co.jp.
authors: Yuta
authors: Y
authors: Kasagi
authors: Hiroshi
authors: H
authors: Saeki
authors: Tomohiko
authors: T
authors: Akahoshi
authors: Junji
authors: J
authors: Kawasaki
authors: Koji
authors: K
authors: Ando
authors: Eiji
authors: E
authors: Oki
authors: Takefumi
authors: T
authors: Ohga
authors: Morimasa
authors: M
authors: Tomikawa
authors: Yoshihiro
authors: Y
authors: Kakeji
authors: Ken
authors: K
authors: Shirabe
authors: Yoshihiko
authors: Y
authors: Maehara
mesh_terms: D021721:Balloon Occlusion / Q000379:methods*; D003244:Consciousness Disorders / Q000209:etiology; D004379:Duodenal Neoplasms / Q000601:surgery*; D005260:Female; D006501:Hepatic Encephalopathy / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000628:therapy*; D012082:Renal Veins / Q000473:pathology*; D013162:Splenic Vein / Q000473:pathology*; D013164:Splenorenal Shunt, Surgical; D016896:Treatment Outcome
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