Mizuiri K, Oshima Y, Ito T, Wakamatsu S, Nakagawa K, Abei T
Jpn J Med. 1983 Jan;22(1):31-6. doi: 10.2169/internalmedicine1962.22.31.
Two cases of portal-systemic shunt were presented. A 70 year-old cirrhotic female, who was suffered from mental confusion, underwent portal venography which demonstrated a large varicose vein connecting the inferior mesenteric vein with the left renal vein. The mean portal pressure was 15 cm saline. There were no esophagogastric varices. A 47 year-old cirrhotic female, who was admitted for evaluation of liver dysfunction found incidentally, underwent portal venography which revealed a dilated coronary vein connecting to the left renal vein. The portal pressure was 23 cm saline. There was no evidence of esophageal varices. Portal venography was performed through the ileocolic vein in both cases. In general, bleeding varices may develop most commonly in coronary-azygous system and less frequently in the territory of the superior and inferior mesenteric veins. On the contrary, retroperitoneal portal-systemic shunts is likely to cause hepatic encephalopathy rather than to develop bleeding varices. Thus, it is necessary to perform abdominal angiography in patients with hematochezia of unknown etiology or recurrent episodes of hepatic encephalopathy.
本文报告了两例门体分流病例。一名70岁的肝硬化女性，患有精神错乱，接受了门静脉造影，结果显示一条大的曲张静脉将肠系膜下静脉与左肾静脉相连。平均门静脉压力为15厘米盐水柱。无食管胃静脉曲张。一名47岁的肝硬化女性，因偶然发现肝功能异常而入院，接受了门静脉造影，结果显示一条扩张的冠状静脉与左肾静脉相连。门静脉压力为23厘米盐水柱。无食管静脉曲张证据。两例均通过回结肠静脉进行门静脉造影。一般来说，曲张静脉出血最常见于冠状-奇静脉系统，较少见于肠系膜上静脉和肠系膜下静脉区域。相反，腹膜后门体分流可能导致肝性脑病，而不是曲张静脉出血。因此，对于病因不明的便血患者或反复发生肝性脑病的患者，有必要进行腹部血管造影。
