Document Detail

Surgical treatment for an extrahepatic portosystemic shunt: a case report.
MedLine Citation:
PMID:  15239266     Owner:  NLM     Status:  MEDLINE    
An extrahepatic portosystemic shunt that has neither liver cirrhosis nor portal hypertension is rare. A 60-year-old Japanese woman who had been suffering chronic liver disease and anemia with mild disorientation was admitted to investigate general fatigue with dizziness and disorientation. The laboratory data revealed mild pancytopenia and liver dysfunction including hyperammoniemia, an increased Indocyanine Green 15-min retention rate, and a decreased Fischer's ratio. Color Doppler ultrasonography, computed tomography, and arterial portography revealed an extrahepatic portosystemic shunt that extended tortuously from the superior mesenteric vein into the inferior vena cava, and decreased blood flow in the main portal vein. Judging from intraoperative measurement of portal pressure and intraoperative portography, shunt ligations were performed at both the efferent portion of shunt from the superior mesenteric vein and the afferent portion of the shunt into the inferior vena cava, and resection of the spleen was also performed. On the postoperative laboratory data, pancytopenia disappeared, and liver function improved. Postoperative abdominal imaging showed increased blood flow in the main portal vein and disappearance of the shunt vessel. Moreover, symptoms present before surgery also disappeared. In conclusion, surgical treatment of extrahepatic portosystemic shunts may result in better postoperative quality of life if it is performed in carefully selected patients.
Tsukasa Hotta; Yasuhito Kobayashi; Katsutoshi Taniguchi; Kiyofumi Johata; Masaki Sahara; Takashi Watanabe; Hiroshi Tanimura; Hiroaki Minakata; Kazuyuki Tsunoi; Yukari T Tsubota
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Hepato-gastroenterology     Volume:  51     ISSN:  0172-6390     ISO Abbreviation:  Hepatogastroenterology     Publication Date:    2004 Jul-Aug
Date Detail:
Created Date:  2004-07-08     Completed Date:  2004-09-21     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8007849     Medline TA:  Hepatogastroenterology     Country:  Greece    
Other Details:
Languages:  eng     Pagination:  1154-8     Citation Subset:  IM    
Department of Surgery, Wakayama Rosai Hospital, Wakayama, Japan.
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MeSH Terms
Chronic Disease
Hyperammonemia / etiology
Liver Diseases / etiology
Mesenteric Veins / abnormalities
Middle Aged
Pancytopenia / etiology
Portal System / abnormalities*,  radiography,  surgery*,  ultrasonography
Postoperative Period
Preoperative Care
Spleen / surgery
Tomography, X-Ray Computed
Treatment Outcome
Ultrasonography, Doppler, Color
Vena Cava, Inferior / abnormalities

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