Successful Surgical Treatment for Inose-type Hepatic Encephalopathy caused by the Porto-systemic Shunt Via Superior Mesenteric Varices: A Case Report

A 78-year-old woman with chronic hepatitis type B who had often gone into a coma of unknown origin since August 1986 was examined in 1999 and found to have high blood NH3->200μg/dl-and superior mesenteric varices with a diameter of 2 cm. Portal phase of mesenteric arteriography showed a massive portosystemic shunt from the ileocecal vein to the vena cava via the varices. She was diagnosed with Inose hepatic encephalopathy and underwent surgery to close the shunt. After confirming that portal venous pressure was less than 180 mmH2O by test clamping of the shunt, varices were resected. Pulsed Doppler ultrasonography showed a significant increase in portal blood inflow to the liver and blood NH3 decreased to 50μg/dl immediately after surgery. Her encephalopathy disappeared completely and she remains healthy with improved liver functional reserve to date.