A SURGICAL CASE OF INTRAHEPATIC PORTO-VENOUS SHUNT WITH PORTAL SYSTEMIC ENCEPHALOPATHY

Intrahepatic porto-venous shunt is a very rare disease. According to retrieval by the author, only 19 cases including the author's have been reported in Japan. Of these, portal systemic encephalopathy occurred in 8 cases, portal branch ligation was performed only 1 case, and the author's was the first hepatectomy case reported among them.The case is a 61-year-old female. She visited the hospital with the chief complaints of lalopathy, dystropy and syncope. Slight liver dysfunction, hyperammonemia and high ICG levels were observed. Abdominal ultrasonic and CT examinations revealed a vascular abnormality in the left hepatic lobe. angiography of the celiac artery detected a shunt between the left portal branch and left hepatic vein. The initial conservative therapy proved ineffective. The lateral hepatic region was resected, so the patient was in good general condition and no severe liver disorder was observed. The neurotic symptoms also disappeared after the operation along with the normalization of various laboratory data. The patient's progress has been good to data without any findings suggestive of portal hypertension. It was considered that cases like the present one showing hepatic encephalopathy with good general condition and good hepatic condition and a shunt localized to one lobe are possible candidates for hepatectomy.