Cosme Jiménez A, Bujanda Fernández de Piérola L, Poch Zapiraín M, Orcolaga Alba R, Ojeda Pérez E, Arenas Miravé J I
Servicio de Digestivo, Hospital Nuestra Señora de Aránzazu, San Sebastián.
Gastroenterol Hepatol. 1995 Nov;18(9):460-3.
Macroscopic intrahepatic portosystemic shunts are extremely rare and may be due to liver injury, congenital vascular malformations or pathologic collaterals secondary to portal hypertension. Forty-eight cases have been reported in the literature up to 1994 with 50-60% presenting cerebral manifestations and 40% being associated with cirrhosis. The case of a patient without cirrhosis who was admitted for upper digestive hemorrhage secondary to gastroduodenal ulcer is described. At 48 hours the patient had an episode of hepatic encephalopathy coinciding with bleeding reactivation. Abdominal echography suggested communication between the right portal and suprahepatic veins and posterior angiography confirmed the diagnosis. Color Doppler echography determined shunt and portal vein blood flow. No case of intrahepatic portosystemic venous shunt as a cause of encephalopathy was found to have been reported in the Spanish literature.
宏观肝内门体分流极为罕见，可能由肝损伤、先天性血管畸形或门静脉高压继发的病理性侧支循环引起。截至1994年，文献报道了48例，其中50 - 60%有脑部表现，40%与肝硬化有关。本文描述了一例无肝硬化的患者，因胃十二指肠溃疡继发上消化道出血入院。48小时时，患者出现肝性脑病发作，同时出血再发。腹部超声提示右门静脉与肝上静脉之间存在交通，后经血管造影确诊。彩色多普勒超声测定了分流和门静脉血流。西班牙文献中未发现有将肝内门体静脉分流作为脑病病因的病例报道。
