Takenaga Shinsuke, Narita Kenichi, Matsui Yo, Fukuda Kunihiko
Department of Radiology, The Jikei University Katsushika Medical Center, Tokyo, Japan.
Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan.
Case Rep Gastroenterol. 2016 Nov 21;10(3):701-705. doi: 10.1159/000452204. eCollection 2016 Sep-Dec.
Hepatic encephalopathy due to intrahepatic portosystemic venous shunts (IPSVS) in a non-cirrhotic condition is rare. Here we report a rare case of a patient with congenital multiple IPSVS successfully treated by percutaneous transhepatic obliteration. The patient was a 67-year-old woman who presented to our hospital with progressive episodes of consciousness disorder and vomiting. Laboratory tests revealed hyperammonemia (192.0 μg/dL), and computed tomography revealed multiple IPSVS in both lobes. There was no evidence of underlying liver disease or hepatic trauma. Transcatheter embolization for IPSVS was performed because conservative therapy was not sufficiently effective. After endovascular shunt closure, hepatic encephalopathy improved. The serum ammonia level normalized during the 5-year follow-up period. Thus, transcatheter embolization may be an effective therapy for patients with symptomatic and refractory IPSVS. Careful follow-up is necessary for portal hypertension-related complications after transcatheter embolization for IPSVS.
非肝硬化状态下由肝内门体静脉分流（IPSVS）引起的肝性脑病较为罕见。在此，我们报告一例先天性多发性IPSVS患者经皮经肝闭塞成功治疗的罕见病例。患者为一名67岁女性，因进行性意识障碍和呕吐前来我院就诊。实验室检查显示高氨血症（192.0μg/dL），计算机断层扫描显示两叶均有多发性IPSVS。无潜在肝脏疾病或肝外伤证据。由于保守治疗效果不佳，对IPSVS进行了经导管栓塞。血管内分流闭塞后，肝性脑病得到改善。在5年随访期内血清氨水平恢复正常。因此，经导管栓塞可能是有症状且难治性IPSVS患者的有效治疗方法。IPSVS经导管栓塞后，对门静脉高压相关并发症进行仔细随访是必要的。
