Published online Jul 7, 2014. doi: 10.3748/wjg.v20.i25.8288
Revised: December 10, 2013
Accepted: January 14, 2014
Published online: July 7, 2014
Spontaneous splenorenal shunts in the absence of cirrhosis have rarely been reported as a cause hyperammonemia with encephalopathy. Several closure techniques of such lesions have been described. Here we report a case of a patient with no history of liver disease who developed significant confusion. After an extensive workup, he was found to have hyperammonemia and encephalopathy due to formation of a spontaneous splenorenal shunt. There was no evidence of cirrhosis on biopsy or imaging and no portal hypertension when directly measured. The shunt was 18 mm and too large for embolization so the segment of the splenic vein between the portal vein and the shunt was occluded using an Amplatzer plug. Thus, the superior mesenteric flow was directed entirely to the liver. After interventional radiology closure of the shunt using this technique there was complete resolution of symptoms. The case represents the first report of a successful closure of splenorenal shunt via percutaneous embolization of the splenic vein with an amplatzer plug using a common femoral vein approach.
Core tip: This is the first reported case of non-portal hypertension associated hepatic encephalopathy related to a large splenorenal shunt that was successfully closed percutaneously with an Amplatzer plug applied to the splenic vein.