A Hepatic Encephalopathy Associated with Noncirrhotic Portosystemic Shunt Serendipitously Completely Responding to Laparoscopic Distal Gastrectomy

• Published in: The Japanese Journal of Gastroenterological Surgery Vol. 50; no. 8; pp. 639 - 645
• Main Authors: Hamano, Ikumi, Matsumoto, Yusuke, Hashimoto, Masashi, Morikawa, Tatsuya, Shimojima, Reiko, Endo, Yoshikatsu, Nobuhisa, Tetsuji, Watanabe, Takanori, Kai, Kyohei, Sato, Shiso
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 01.08.2017
• Subjects: gastric cancer; laparoscopic gastrectomy; portosystemic shunt
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.2016.0136

We report a case of early gastric cancer with a portosystemic shunt. A 59-year-old man was given a diagnosis of early gastric cancer by an upper gastrointestinal endoscopy and referred to our hospital for surgery. A preoperative blood test showed no abnormalities in the hepatic function, but the serum ammonia level was slightly elevated and abdominal enhanced CT revealed a shunt blood vessel from the left gastric vein to the left renal vein. The patient was a social drinker and had no history of liver disease. A laparoscopic distal gastrectomy was performed for early gastric cancer and the left gastric vein as the shunt vessel was cut off during the nodal dissection at the upper level of the pancreas. After surgery, the serum ammonia level became normal and the patient’s irritability, which was attributed to his character before surgery, improved. As the symptoms of hepatic encephalopathy are diverse, sometimes diagnoses are difficult. In addition, a portosystemic shunt may cause hyperammonemia in patients without a history of liver disease. Even in extremely rare vascular patterns, such as in this case, it is possible to perform laparoscopic surgery successfully by simulation using preoperative CT-angiography.