Non-cirrhotic portal-systemic encephalopathy caused by enlargement of a splenorenal shunt after pancreaticoduodenectomy for locally advanced duodenal cancer: report of a case

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• 作者：Yuta Kasagi (1)
  Hiroshi Saeki (1)
  Tomohiko Akahoshi (1)
  Junji Kawasaki (1)
  Koji Ando (1)
  Eiji Oki (1)
  Takefumi Ohga (1)
  Morimasa Tomikawa (1)
  Yoshihiro Kakeji (1)
  Ken Shirabe (1)
  Yoshihiko Maehara (1)
  
• 关键词：Encephalopathy ; Splenorenal shunt ; Duodenal cancer ; Pancreaticoduodenectomy ; Balloon ; occluded retrograde transvenous obliteration
• 刊名：Surgery Today
• 出版年：2014
• 出版时间：August 2014
• 年：2014
• 卷：44
• 期：8
• 页码：1573-1576
• 全文大小：729 KB
• 参考文献：1. Sherlock S, Snmmerskill WHJ, White LP, Phear EA. Portal-systemic encephalopathy, neurological complications of liver disease. Lancet. 1954;4:453-. CrossRef
  2. Watanabe A. Portal-systemic encephalopathy in non-cirrhotic patients: classification of clinical types, diagnosis and treatment. J Gastroenterol Hepatol. 2000;15:969-9. CrossRef
  3. Mima K, Kakeji Y, Saeki H, Yoshida R, Yoshinaga K, Morita M, et al. Chemotherapy with TS-1?+?CDDP followed by curative operation for locally advanced duodenal cancer (in Japanese with English abstract). Nihon Syokakigeka Gakkaizassi (JPN J Gastroenterol Surg). 2011;44:836-1. CrossRef
  4. Raskin NH, Price JB, Fishman RA. Portal-systemic encephalopathy due to congenital intrahepatic shunt. N Engl J Med. 1964;270:225-. CrossRef
  5. Inose T. A specific form of hepatocerebral degeneration (in Japanese with English abstract). Seishinshi. 1950;51:245-0.
  6. Moncuore AC, Waltman AC, Vendersalm TJ, Linyon RR, Levine FH, Abbott WM. Gastrointestinal hemorrhage from adhesion related mesenteric-caval shunt. Ann Surg. 1976;183:24-. CrossRef
  7. Edwars EA. Functional anatomy of the portal-systemic communications. Arch Intern Med. 1951;88:137-4. CrossRef
  8. Akahosi T, Nishizaki T, Wakasugi K, Mastuzaka T, Kume K, Yamamoto I, et al. Portal-systemic encephalopathy due to a congenital extrahepatic portosystemic shunt. Hepatogastroenterology. 2000;47:1113-.
  9. Ito K, Kudo A, Nakamura N, Tanaka S, Teramoto K, Arii S. Left-sided portal hypertension caused by serous cystadenoma of the pancreas: report of a case. Surg Today. 2008;38:184-. CrossRef
  10. Hirota S, Matumoto S, Tomita M, Sako M, Kono M. Retrograde transvenous obliteration of gastric varices. Radiology. 1999;211:349-4. CrossRef
  11. Kimoto M, Imamura M, Kamada K, Aikata H, Kawakami Y, Matsumoto A, et al. Balloon-occluded retrograde transvenous obliteration of gastric fundal varices with hemorrhage. Am J Roentgenol. 2002;178:1167-4. CrossRef
  12. Kawanaka H, Ohta M, Hashizume M, Tomikawa M, Higashi H, Kishihara F, et al. Portosystemic encephalopathy treated with balloon-occluded retrograde transvenous obliteration. Am J Gastroenterol. 1995;90:508-0.
  13. Akahoshi T, Hashizume M, Tomikawa M, Kawanaka H, Yamaguchi S, et al. Long-term results of balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding and risky gastric varices: a 10-year experience. J Gastroenterol Hepatol. 2008;23(11):1702-. CrossRef
  
• 作者单位：Yuta Kasagi (1)
  Hiroshi Saeki (1)
  Tomohiko Akahoshi (1)
  Junji Kawasaki (1)
  Koji Ando (1)
  Eiji Oki (1)
  Takefumi Ohga (1)
  Morimasa Tomikawa (1)
  Yoshihiro Kakeji (1)
  Ken Shirabe (1)
  Yoshihiko Maehara (1)
  
  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
  
• ISSN：1436-2813

文摘

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. Fig.?1 Review of abdominal computed tomography scans. a Preoperatively, b 6?months postoperatively, c 1?year postoperatively, d 2?years and 2?months postoperatively. The shunt vessel gradually enlarged after pancreaticoduodenectomy (circle)