Journal article
Portosystemic encephalopathy due to mesoiliac shunt in a patient without cirrhosis
Journal of clinical gastroenterology, Vol.44(5), pp.381-383
05/2010
DOI: 10.1097/MCG.0b013e3181aae51b
PMCID: PMC2858247
PMID: 19636259
Abstract
Hepatic encephalopathy most commonly occurs in patients with cirrhosis and end-stage liver disease, however, the disorder can also occur in the presence of intrahepatic or extrahepatic shunts when the intrahepatic circulation is effectively bypassed. The majority of extrahepatic shunts described to date develop between a mesenteric vein and inferior vena cava. Herein we report a novel case of a superior mesenteric vein to left internal iliac vein shunt that led to hepatic encephalopathy in a 57-year-old woman with no apparent underlying liver disorder. The patient presented with confusion, disorientation, and hyperammonemia. Workup for parenchymal liver disease was negative and liver biopsy findings did not show significant liver disease. Magnetic resonance imaging revealed a serpiginous 1-cm-wide shunt that diverted superior mesenteric vein blood from the portal confluence to the left internal iliac vein. Surgical closure of the shunt led to marked improvement of the patient with the resolution of hepatic encephalopathy. This report is the first description of a portosystemic shunt, likely congenital, linking these 2 vessels resulting in clinically significant hepatic encephalopathy. The findings emphasize that abdominal and pelvic imaging should be considered in patients with signs of hepatic encephalopathy that have none to minimal hepatic disease.
Details
- Title: Subtitle
- Portosystemic encephalopathy due to mesoiliac shunt in a patient without cirrhosis
- Creators
- Sobia Ali - Department of Internal Medicine, Roy J and Lucille A Carver College of Medicine, University of Iowa and Veterans Administration Medical Center, Iowa City, IA 52242, USAAlan H StolpenWarren N Schmidt
- Resource Type
- Journal article
- Publication Details
- Journal of clinical gastroenterology, Vol.44(5), pp.381-383
- DOI
- 10.1097/MCG.0b013e3181aae51b
- PMID
- 19636259
- PMCID
- PMC2858247
- NLM abbreviation
- J Clin Gastroenterol
- ISSN
- 0192-0790
- eISSN
- 1539-2031
- Publisher
- United States
- Grant note
- I01 BX000159 / BLRD VA R21 DK068453 / NIDDK NIH HHS R21 DK068453-01 / NIDDK NIH HHS R21 DK068453-01A1 / NIDDK NIH HHS
- Language
- English
- Date published
- 05/2010
- Academic Unit
- Radiology; Gastroenterology and Hepatology; Internal Medicine
- Record Identifier
- 9984051703502771
Metrics
15 Record Views