Novel therapy for non-cirrhotic hyperammonemia due to a spontaneous splenorenal shunt.

Abstract

Spontaneous splenorenal shunts in the absence of cirrhosis have rarely been reported as a cause hyperammonemia with encephalopathy. Several closure techniques of such lesions have been described. Here we report a case of a patient with no history of liver disease who developed significant confusion. After an extensive workup, he was found to have hyperammonemia and encephalopathy due to formation of a spontaneous splenorenal shunt. There was no evidence of cirrhosis on biopsy or imaging and no portal hypertension when directly measured. The shunt was 18 mm and too large for embolization so the segment of the splenic vein between the portal vein and the shunt was occluded using an Amplatzer plug. Thus, the superior mesenteric flow was directed entirely to the liver. After interventional radiology closure of the shunt using this technique there was complete resolution of symptoms. The case represents the first report of a successful closure of splenorenal shunt via percutaneous embolization of the splenic vein with an amplatzer plug using a common femoral vein approach.

• Authors: Shari S Rogal, Angela Hu, Rupal Bandi, Obaid Shaikh
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 20 Issue 25 Pg. 8288-91 (Jul 07 2014) ISSN: 2219-2840 [Electronic] United States
• PMID: 25009405 (Publication Type: Case Reports, Journal Article, Research Support, U.S. Gov't, Non-P.H.S.)

Topics

• Confusion (etiology)
• Embolization, Therapeutic (instrumentation)
• Hepatic Encephalopathy (diagnosis, etiology, physiopathology, therapy)
• Humans
• Hyperammonemia (diagnosis, etiology, physiopathology, therapy)
• Male
• Middle Aged
• Regional Blood Flow
• Renal Veins (diagnostic imaging, physiopathology)
• Splenic Vein (diagnostic imaging, physiopathology)
• Tomography, X-Ray Computed
• Treatment Outcome