Large extrahepatic portosystemic shunt without portal hypertension

Abstract

Extrahepatic portosystemic shunt usually occurs secondary to severe portal hypertension, and it is rare to encounter it in patients without portal hypertension. We report herein a large extrahepatic portosystemic shunt between the left gastric vein and left renal vein without portal hypertension in which color Doppler sonography was useful not only for detection but evaluation of the effect of embolization.

Portal‐systemic shunt encephalopathy presenting with diffuse cerebral white matter lesion: An autopsy case

“…To conclude that the gastro‐renal shunt contributed to neurological symptoms is difficult, because of the slight increase in serum ammonia level and small shunt vessels. The shunt vessels were large enough to develop the encephalopathy and serum ammonia levels were high in previous reports of PSE 9–12 …”

“…The shunt vessels were large enough to develop the encephalopathy and serum ammonia levels were high in previous reports of PSE. [9][10][11][12] However, pathological findings were consistent with PSE, with the exception of severe tissue rarefaction due to severe loss of myelin and axons in the cerebral deep white matter. Thus PSE was diagnosed on the basis of neurological symptoms and pathological findings.…”

“…Neuropathological findings show Alzheimer type II cells and spongiform changes in the gray matter 8 . Some investigators have recently claimed to have observed PSE in patients without liver cirrhosis or portal hypertension 9–12 . Although clinical and radiological findings were well described, neuropathological examinations of brain tissue from autopsy were limited in those cases.…”

Insight into congenital absence of the portal vein: Is it rare?

“…However, the most important advantage of this technique is its noninvasiveness and no requirement for anesthesia. It yields much useful information about the detailed vascular anatomy as well as hemodynamics [104] . Prenatal screening and intraoperative ultrasonography is especially superior to other techniques [104] .…”

“…It yields much useful information about the detailed vascular anatomy as well as hemodynamics [104] . Prenatal screening and intraoperative ultrasonography is especially superior to other techniques [104] . Although color Doppler sonography first depicted the image of the absent portal vein in most cases, ultrasonography (US) may fail to accurately detect the associated extrahepatic shunts because of its subtle US features [31] .…”