[A Case of Perihilar Cholangiocarcinoma with Postoperative Hepatic Encephalopathy Due to Portosystemic Shunt Treated by Percutaneous Embolization].

Abstract

An 83-year-old woman developed jaundice, and was diagnosed as perihilar cholangiocarcinoma. Abdominal contrast- enhanced CT revealed coexisting portosystemic shunt between portal vein and inferior vena cava, however, her blood ammonia level was normal. She underwent right hemihepatectomy and caudate lobectomy combined with extrahepatic bile duct resection and portal vein resection. Postoperatively, hyperammonemia refractory to conservative treatment was observed. The blood ammonia level increased to 180μg/dL and she was suffered from grade Ⅲ hepatic encephalopathy on the 20th postoperative day. CT showed an increase in the diameter of the portosystemic shunt, while there was only a slight increase in the remnant left lobe of the liver. These findings indicated that hepatic encephalopathy was caused by increased portosystemic shunt blood flow and decreased portal venous flow. Hepatic encephalopathy was rapidly improved by percutaneous transhepatic portosystemic shunt obliteration.

• Authors: Takashi Murakami, Hiroaki Shimizu, Norikazu Yogi, Isamu Hosokawa, Hiroyuki Nojima, Tatsuya Ohno, Shutaro Hike, Akihiro Usui, Chihiro Kosugi, Kiyohiko Shuto, Masato Yamazaki, Keiji Koda
• Journal: Gan to kagaku ryoho. Cancer & chemotherapy (Gan To Kagaku Ryoho) Vol. 50 Issue 1 Pg. 102-104 (Jan 2023) ISSN: 0385-0684 [Print] Japan
• PMID: 36760000 (Publication Type: Case Reports, English Abstract, Journal Article)

Chemical References

• Ammonia

Topics

• Humans
• Female
• Aged, 80 and over
• Klatskin Tumor (complications)
• Hepatic Encephalopathy (etiology, therapy)
• Ammonia
• Portasystemic Shunt, Transjugular Intrahepatic (adverse effects)
• Bile Duct Neoplasms (complications, surgery, pathology)