Treatment of portosystemic shunt-borne hepatic encephalopathy in a 97-year-old woman using balloon-occluded retrograde transvenous obliteration:A case report  

作　　者：Akihiro Nishi Tsuneaki Kenzaka Misa Sogi Shuichiro Nakaminato Takahiro Suzuki 

机构地区：[1]General Medicine,Awa Regional Medical Center,Tateyama 2940014,Chiba,Japan [2]Division of Community Medicine and Career Development,Kobe University Graduate School of Medicine,Kobe 6500017,Hyogo,Japan [3]Department of Radiology,Kameda Medical Center,Kamogawa 2968602,Chiba,Japan

出　　处：《World Journal of Clinical Cases》2023年第4期945-951,共7页世界临床病例杂志

摘　　要：BACKGROUND Hyperammonemia and hepatic encephalopathy are common in patients with portosystemic shunts.Surgical shunt occlusion has been standard treatment,although recently the less invasive balloon-occluded retrograde transvenous obliteration(B-RTO)has gained increasing attention.Thus far,there have been no reports on the treatment of portosystemic shunts with B-RTO in patients aged over 90 years.In this study,we present a case of hepatic encephalopathy caused by shunting of the left common iliac and inferior mesenteric veins,successfully treated with B-RTO.CASE SUMMARY A 97-year-old woman with no history of liver disease was admitted to our hospital because of disturbance of consciousness.She had no jaundice,spider angioma,palmar erythema,hepatosplenomegaly,or asterixis.Her blood tests showed hyperammonemia,and abdominal contrast-enhanced computed tomography revealed a portosystemic shunt running between the left common iliac vein and the inferior mesenteric vein.She was diagnosed with hepatic encephalopathy secondary to a portosystemic shunt.The patient did not improve with conservative treatment:Lactulose,rifaximin,and a low-protein diet.B-RTO was performed,which resulted in shunt closure and improvement in hyperammonemia and disturbance of consciousness.Moreover,there was no abdominal pain or elevated levels of liver enzymes due to complications.The patient was discharged without further consciousness disturbance.CONCLUSION Portosystemic shunt-borne hepatic encephalopathy must be considered in the differential diagnosis for consciousness disturbance,including abnormal behavior and speech.

关 键 词：Hepatic encephalopathy HYPERAMMONEMIA Portosystemic shunt Balloon-occluded retrograde transvenous obliteration ELDERLY Case report 

分 类 号：R657.3[医药卫生—外科学]