Document Detail

Recurring encephalopathy abolished by gastrorenal shunt ligation in a diabetic hemodialysis patient.
MedLine Citation:
PMID:  9468259     Owner:  NLM     Status:  MEDLINE    
A 57-year-old man was admitted to our hospital for hepatic encephalopathy. He previously had undergone a partial gastrectomy for gastric ulcer, and also had been on maintenance hemodialysis because of diabetic nephropathy. Despite treatment with branched-chain amino acids and lactulose, encephalopathy occurred repeatedly. The findings of his laboratory examinations, computed tomography, and liver biopsy were not suggestive of chronic liver damage. Angiography revealed a portal-systemic shunt from the superior mesenteric vein via the left gastric vein to the left renal vein. A ligation of the gastrorenal shunt was performed. After the shunt ligation, hepatic encephalopathy no longer recurred, and no medication was required to prevent it. The insulin requirements also decreased, the plasma ammonia concentration then decreased, and serum concentration of several amino acids related to the ammonia metabolism also decreased. The molar ratio of branched-chain amino acids to aromatic amino acids increased. The ligation of the portal-systemic shunt was thus considered to be the key to the successful treatment of hepatic encephalopathy in this unusual case.
J Shimono; H Tsuji; K Azuma; M Hashiguchi; M Fujishima
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  93     ISSN:  0002-9270     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  1998 Feb 
Date Detail:
Created Date:  1998-02-25     Completed Date:  1998-02-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  270-2     Citation Subset:  IM    
Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
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MeSH Terms
Diabetic Nephropathies / therapy*
Hepatic Encephalopathy / etiology*
Middle Aged
Renal Dialysis*
Renal Veins* / surgery
Stomach / blood supply*
Vascular Fistula / complications,  surgery*
Veins / surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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