Related Experiment Videos
Large spleno-caval shunt not accompanied by cirrhosis or encephalopathy
H Mitsui1, N Hashimoto, M Isshiki
1First Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Japan.
Journal of Gastroenterology
|April 1, 1996
Summary
A rare large spleno-caval shunt via the azygos vein was found in a patient without advanced liver disease or hepatic encephalopathy. This case highlights unusual presentations of portal-systemic shunts.
Area of Science:
- Vascular Surgery
- Hepatology
- Radiology
Background:
- Portal-systemic shunts are abnormal connections between the portal vein and systemic circulation.
- They are typically associated with advanced liver disease and complications like hepatic encephalopathy.
- Spleno-caval shunts, specifically, are uncommon vascular anomalies.
Observation:
- A 40-year-old man presented with abnormal liver function tests, leading to the incidental discovery of a large spleno-caval shunt.
- Imaging (ultrasonography, CT, MRI, angiography) confirmed a large shunt from the splenic vein to the superior vena cava via the coronary and azygos veins.
- Despite being a hepatitis B virus carrier with a history of heavy drinking, the patient had mild chronic hepatitis without cirrhosis or esophageal varices.
Findings:
- Hemodynamic evaluation revealed slightly elevated hepatic venous wedge pressure and reduced hepatic blood flow (50% of normal).
- The patient exhibited no clinical signs or history of hepatic encephalopathy, a common complication of such shunts.
- This presentation is rare due to the absence of significant liver disease and encephalopathy despite a large portal-systemic shunt.
Implications:
- This case challenges the typical understanding of spleno-caval shunt pathophysiology and clinical manifestations.
- It suggests that significant portal-systemic shunting can occur without severe liver disease or overt encephalopathy.
- Further research into the compensatory mechanisms and long-term outcomes in such unique cases is warranted.