noncirrhotic extrahepatic portosystemic shunt causing adult-onset encephalopathy treated with endovascular closure

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ID: 185373
2015
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Abstract
A 54-year-old woman presented with a six-month history of episodic confusion and progressive ataxia. A comprehensive metabolic panel was notable for elevated values of alkaline phosphatase (161 U/L), total bilirubin (1.5 mg/dL), and serum ammonia of 300 umol/L (normal range 9–47). Hepatitis panel, relevant serological tests, tumor markers (CA-19-9, CEA), and urea cycle enzyme studies were unrevealing. Lactulose and rifaximin therapy failed to normalize serum ammonia levels. Imaging revealed a structural vascular abnormality communicating between an enlarged inferior mesenteric vein and the left renal vein, measuring 16 mm in greatest diameter. The diagnosis of congenital extrahepatic portosystemic shunt was made and endovascular shunt closure was performed using a 22 mm Amplatzer II vascular plug. Within a day, serum ammonia levels normalized. Lactulose and rifaximin were discontinued, and confusion and ataxia resolved.
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elnekave2015casenoncirrhotic Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;Eldad Elnekave;Eugenia Belenky;Lindsley Van der Veer
Journal faṣlnāmah-i pizhūhish/hā-yi rāhburdī-i siyāsat
Year 2015
DOI
10.1155/2015/852853
URL
http://dx.doi.org/10.1155/2015/852853
Keywords
medical physics nuclear medicine medical radiology

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