A Case of a Portal Hepatic Venous Shunt via an Intrahepatic Portal Vein Aneurysm Effectively Treated with Ligation of a Portal Vein Branch

• Published in: Nippon Shokaki Geka Gakkai zasshi Vol. 29; no. 8; pp. 1787 - 1791
• Main Authors: Tanaka, Reiichiro, Kamasako, Akira, Kawamoto, Shunsuke, Miki, Keita, Matano, Ichiro, Murakami, Atsushi, Yamaguchi, Takashi, Sato, Masami
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 1996
• Subjects: a portal hepatic venous shunt via an intrahepatic portal vein aneurysm; ligation of the left branch of portal vein; portosystemic encephalopathy
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.29.1787

Reports of a portal hepatic venous shunt (PHVS) via an intrahepatic portal vein aneurysm (IPVA) are extremely rare, though they have gradually increased with the development of the diagnostic imaging technology of today. We present a case of a PHVS via an IPVA effectively treated with ligation of a portal vein branch. A 71-year-old man with early gastric cancer (IIa, sm, tub2, n0) was admitted for an operation, and CT and MRI revealed a PHVS via an IPVA measuring 3×3×4 cm in the anterior lateral segment (S3) of the left lobe of the liver. There was no ascites or esophageal varices, but there was splenomegaly. His laboratory data were: prothrombin time 100%; total serum bilirubin 1.2mg/dl; HCV positive; white blood cell count 3100/mm3; platelet count 11×104/mm3; plasma ammonia 130μ/dl; ICG15 47%. Although there are no abnormalities were found by electroencepharography, neurological examination revealed scanning speech and gait ataxia and other abnormalities. He had Child class A liver cirrhosis except such neurological symptoms. On 11/29/94 we performed ligaton of a portaI vein branch (P3) and a partial gastrectomy and splenectomy. Portal vein pressure showed no change after the operation (16.5→16.4cmH2O). Laboratory data were improved after the operation: plasma ammonia 31μg/dl; ICG 15 26%. Neurological symptoms were also improved significantly. Endoscopy has revealed no esophageal varices yet.