Acquired Portosystemic Shunts in Cirrhosis and Portal Vein Thrombosis: A Case Report

Acquired portosystemic shunts (PSS) are abnormal blood vessels that develop between the portal vein and systemic circulation as a result of portal hypertension. Recurrent hyperammonemic encephalopathy in our 62-year-old patient with cirrhosis and chronic portal vein thrombosis led to the discovery of an extremely rare and functioning portosystemic shunt (PSS). The PSS connected the inferior mesenteric and left renal veins. Such shunts are considered pathological structures and may require surgical intervention. The large PSS reported herein likely provided decompression of the portal hypertension. The concurrence of portal vein thrombosis clearly precluded any consideration of surgery. Therapeutic management in each instance of these shunts requires a full understanding of their origination, location, and physiologic implications.