Hybrid Surgery for Portosystemic Encephalopathy in a Patient with Liver Cirrhosis: a case report.

Abstract

Regarding the treatment for a portosystemic shunt, surgical or interventional radiological closure of the shunt was established. Interventional radiology including balloon-occluded retrograde transvenous obliteration can worsen portal hypertension and create a large thrombus close to the major venous system in the case of a huge portosystemic shunt. In contrast, it is also difficult to treat some cases through surgery alone when huge complicated shunts exist very deep in the body. Herein, we report a successful case of surgical shunt ligation for portosystemic encephalopathy in a hybrid operation room that enabled intraoperative angiography and computed tomography. A 62-year-old woman with chronic hepatitis C was referred to our hospital due to high levels of serum ammonia and hepatic encephalopathy. She had a massive, complicated portosystemic shunt from the inferior mesenteric vein to the left renal vein but did not have esophageal or gastric varices. It was difficult to occlude the portosystemic shunt by interventional radiologic techniques because the shunt had an extremely large amount of blood flow and many collateral routes. We performed the shunt ligation in the hybrid operation room. Intraoperative angiography provided detailed information about the portosystemic shunt, such as direction or volume of blood flow and collateral routes in real time. Her encephalopathy disappeared completely and she remains healthy with improved liver functional reserve to date. In conclusion, this is a successful case of a hybrid operation for an extremely large and complicated portosystemic shunt, providing for intraoperative angiography as a safe and reliable surgical treatment for portosystemic encephalopathy in patients with liver cirrhosis.

• Authors: Yuki Imaoka, Masahiro Ohira, Shintaro Kuroda, Hiroyuki Tahara, Kentaro Ide, Kohei Ishiyama, Tsuyoshi Kobayashi, Masaki Ishikawa, Kazuo Awai, Hideki Ohdan
• Journal: Hiroshima journal of medical sciences (Hiroshima J Med Sci) Vol. 66 Issue 1 Pg. 11-15 (Mar 2017) ISSN: 0018-2052 [Print] Japan
• PMID: 29986123 (Publication Type: Case Reports, Journal Article)

Topics

• Collateral Circulation
• Computed Tomography Angiography
• Female
• Hepatic Encephalopathy (diagnostic imaging, etiology, physiopathology, surgery)
• Humans
• Ligation
• Liver Circulation
• Liver Cirrhosis (complications, diagnosis)
• Mesenteric Veins (diagnostic imaging, physiopathology, surgery)
• Middle Aged
• Ovary (blood supply)
• Phlebography (methods)
• Portal Pressure
• Radiography, Interventional
• Treatment Outcome
• Vascular Surgical Procedures