Portal‐systemic encephalopathy from a spontaneous gastrorenal shunt diagnosed by three‐dimensional computed tomography and treated effectively by percutaneous vascular embolization

Abstract

Liver ISSN 0106-9543Portal-systemic encephalopathy from a spontaneous gastrorenal shunt diagnosed by three-dimensional computed tomography and treated effectively by percutaneous vascular embolization Kuramitsu T, Komatsu M, Matsudaira N, Naganuma T, Niizawa M, Zeniya A, Yoshida T, Toyoshima I, Chiba M, Masamune 0. Portal-systemic encephalopathy from a spontaneous gastrorenal shunt diagnosed by three-dimensional computed tomography and treated effectively by percutaneous vascular embolization.Abstract: A 67-year-old man with a portal-systemic shunt confirmed by three-dimensional computed tomography (3D-CT) was successfully treated by percutaneous vascular embolization. The patient had aggravated loss of memory, disorientation, and hyperammonemia. A gastrorenal shunt 16 mm in diameter was found by 3D-CT reconstructed by helical computed tomography (CT). Embolization was performed only in the shunt percutaneously through the inferior vena cava. One year after the embolization, no recurrence of portal-systemic encephalopathy and no portal hypertension have appeared, and the clinical course has been good.

Portosystemic Encephalopathy without Liver Cirrhosis Masquerading as Depression

“…According to our literature review, 24 cases of portosystemic encephalopathy without liver cirrhosis have been reported, including 20 from East Asia (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) and four from the USA (16)(17)(18)(19), since Raskin et al reported the first case in 1964 (16). Previous studies involved mostly women (83%), with a mean age of 67.5 years (range: 37-86 years).…”

Systematic review of congenital and acquired portal-systemic shunts in otherwise normal livers

“…Several studies used Doppler ultrasound imaging and scintigraphy to measure shunt rate and size, with many reporting the PSS to be ‘large’ or with a diameter ranging from 0·2 to 5 cm. It has been suggested that encephalopathy is not associated with PSSs, even in patients with cirrhotic livers, if the shunted fraction is less than 24–30 per cent.…”

Treatment of chronic portosystemic encephalopathy in cirrhotic patients by embolization of portosystemic shunts

“…Various percutaneous routes (femoral, transjugular, brachial, transhepatic, transileocolic, ileal) have been described (2,4,15). Literature reporting the radiological management of chronic portosystemic encephalopathy (CPSE) is scarce, mostly represented by small and heterogeneous series (7,8,16,17) or single case reports (9,10,14,15,19,20), mainly from Japanese authors with usually 1 year or more encephalopathy-free survival (5,8,16). Uflacker et al (18) first reported in 1987 a promising series of five patients presenting with CPSE selected for radiological interventional management.…”