A Case of Non-cirrhotic Hepatic Encephalopathy with Hyperammonemia Who Underwent Balloon-occluded Retrograde Transvenous Obliteration (B-RTO) of the Superior Mesenteric Vein-Renal Vein Shunt

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  • Sato Takayuki
    Department of Emergency and Critical Care Medicine, Ushiku Aiwa General Hospital
  • Suga Hiroyasu
    Department of Emergency Medicine, TMG Asaka Medical Center
  • Deguchi Yoshizumi
    Department of Emergency and Critical Care Medicine, Ushiku Aiwa General Hospital
  • Nakagawa Takao
    Department of Surgery, Miyota Central Memorial Hospital

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Other Title
  • 高アンモニア血症から発見された上腸間膜静脈－腎静脈短絡に対し，バルーン閉塞下逆行性経静脈塞栓術（B-RTO）が著効した非肝硬変性肝性脳症の1例
  • コウアンモニア ケッショウ カラ ハッケン サレタ ジョウチョウカンマク ジョウミャク-ジンジョウミャク タンラク ニ タイシ,バルーン ヘイソク カ ギャッコウセイケイ ジョウミャク ソクセンジュツ(B-RTO)ガ チョコウシタ ヒカンコウヘンセイ カンセイ ノウショウ ノ 1レイ

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Abstract

<p>The origin of hepatic encephalopathy with disturbed consciousness includes portosystemic shunts other than metabolic disorders such as Wilson disease, urea cycle enzyme deficiency, amino acid metabolism abnormalities, and disordered liver parenchymal function. We found favorable outcomes of balloon-occluded retrograde transvenous obliteration (B-RTO) to treat a superior mesenteric vein-left renal vein shunt resulting from repeated episodes of hyperammonemia. A 68-year-old man was admitted to hospital three times with disturbed consciousness of unknown origin. Hyperammonemia and a superior mesenteric vein-renal vein shunt were finally identified, and B-RTO was performed, which resulted in decreased ammonia levels and improved consciousness. The patient has since remained free of recurrence. We consider that B-RTO is effective for treating non-cirrhotic hepatic encephalopathy associated with a portosystemic shunt.</p>

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