Portacaval diversion for severe hypercholesterolemia. Report of a case with measurements of glucose tolerance, insulin, and glucagon levels.

An end-to-side portacaval shunt was performed in a patient with severe coronary arteriosclerosis and type IIa hypercholesterolemia. By one year postoperatively there was a decrease of serum cholesterol concentration of more than 40%. No adverse side effects were noted. Intravenous and oral glucose tolerance tests were performed and were within normal range preoperatively and postoperatively. However, preoperatively, during the oral test, the serum insulin levels exceeded the normal range. In addition, glucagon levels revealed less tendency to suppression during the preoperative oral tests. Psychological testing revealed no abnormalitites, and serum ammonia levels were only slightly elevated.