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Disabling portosystemic encephalopathy in a non-cirrhotic patient: successful endovascular treatment of a giant inferior mesenteric-caval shunt via the left internal iliac vein

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World Journal of Gastroenterology 2017年第47期23卷 8426-8431页

作者： luca de Martinis Gloria Groppelli Riccardo Corti Lorenzo Paolo Moramarco Pietro Quaretti Pasquale De Cata Mario Rotondi luca chiovato Unit of Endocrinology and Internal Medicine University of PaviaICS Maugeri SPA SocietàBenefit Unit of Interventional Radiology Radiology DepartmentIRCCS Fondazione Policlinico San Matteo

Hepatic encephalopathy is suspected in non-cirrhotic cases of encephalopathy because the symptoms are accompanied by hyperammonaemia. Some cases have been misdiagnosed as psychiatric diseases and consequently patients hospitalized in psychiatric institutions or geriatric facilities. Therefore, the importance of accurate diagnosis of this disease should be strongly emphasized. A 68-year-old female patient presented to the Emergency Room with confusion, lethargy, nausea and vomiting. Examination disclosed normal vital signs. Neurological examination revealed a minimally responsive woman without apparent focal deficits and normal reflexes. She had no history of hematologic disorders or alcohol abuse. Her brain TC did not demonstrate any intracranial abnormalities and electroencephalography did not reveal any subclinical epileptiform discharges. Her ammonia level was > 400 mg/d L(reference range < 75 mg/d L) while hepatitis viral markers were negative. The patient was started on lactulose, rifaximin and low-protein *** the basis of the doppler ultrasound and abdomen computed tomography angiography findings, the decision was made to attempt portal venography which confirmed the presence of a giant portal-systemic venous shunt. Therefore, mechanic obliteration of shunt by interventional radiology was performed. As a consequence, mesenteric venous blood returned to hepatopetally flow into the liver, metabolic detoxification of ammonia increased and hepatic encephalopathy subsided. It is crucial that physicians immediately recognize the presence of non-cirrhotic encephalopathy, in view of the potential therapeutic resolution after accurate diagnosis and appropriate treatments.

关键词： Non-cirrhotic patient Portosystemic shunt Hyperammonaemia Interventional radiology Mechanical embolization Encephalopathy

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