Abstract
Hepatic encephalopathy is suspected in non-cirrhotic cases of encephalopathy because the symptoms are accompanied by hyperammonaemia. Some cases have been misdiagnosed as psychiatric diseases and consequently patients hospitalized in psychiatric institutions or geriatric facilities. Therefore, the importance of accurate diagnosis of this disease should be strongly emphasized. A 68-year-old female patient presented to the Emergency Room with confusion, lethargy, nausea and vomiting. Examination disclosed normal vital signs. Neurological examination revealed a minimally responsive woman without apparent focal deficits and normal reflexes. She had no history of hematologic disorders or alcohol abuse. Her brain TC did not demonstrate any intracranial abnormalities and electroencephalography did not reveal any subclinical epileptiform discharges. Her ammonia level was > 400 mg/dL (reference range < 75 mg/dL) while hepatitis viral markers were negative. The patient was started on lactulose, rifaximin and low-protein diet. On the basis of the doppler ultrasound and abdomen computed tomography angiography findings, the decision was made to attempt portal venography which confirmed the presence of a giant portal-systemic venous shunt. Therefore, mechanic obliteration of shunt by interventional radiology was performed. As a consequence, mesenteric venous blood returned to hepatopetally flow into the liver, metabolic detoxification of ammonia increased and hepatic encephalopathy subsided. It is crucial that physicians immediately recognize the presence of non-cirrhotic encephalopathy, in view of the potential therapeutic resolution after accurate diagnosis and appropriate treatments.
| Original language | English |
|---|---|
| Pages (from-to) | 8426-8431 |
| Number of pages | 6 |
| Journal | World Journal of Gastroenterology |
| Volume | 23 |
| Issue number | 47 |
| DOIs | |
| Publication status | Published - Dec 21 2017 |
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Keywords
- Encephalopathy
- Hyperammonaemia
- Interventional radiology
- Mechanical embolization
- Non-cirrhotic patient
- Portosystemic shunt
ASJC Scopus subject areas
- Gastroenterology
Cite this
Disabling portosystemic encephalopathy in a non-cirrhotic patient : Successful endovascular treatment of a giant inferior mesenteric-caval shunt via the left internal iliac vein. / De Martinis, Luca; Groppelli, Gloria; Corti, Riccardo; Moramarco, Lorenzo Paolo; Quaretti, Pietro; De Cata, Pasquale; Rotondi, Mario; Chiovato, Luca.
In: World Journal of Gastroenterology, Vol. 23, No. 47, 21.12.2017, p. 8426-8431.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Disabling portosystemic encephalopathy in a non-cirrhotic patient
T2 - Successful endovascular treatment of a giant inferior mesenteric-caval shunt via the left internal iliac vein
AU - De Martinis, Luca
AU - Groppelli, Gloria
AU - Corti, Riccardo
AU - Moramarco, Lorenzo Paolo
AU - Quaretti, Pietro
AU - De Cata, Pasquale
AU - Rotondi, Mario
AU - Chiovato, Luca
PY - 2017/12/21
Y1 - 2017/12/21
N2 - Hepatic encephalopathy is suspected in non-cirrhotic cases of encephalopathy because the symptoms are accompanied by hyperammonaemia. Some cases have been misdiagnosed as psychiatric diseases and consequently patients hospitalized in psychiatric institutions or geriatric facilities. Therefore, the importance of accurate diagnosis of this disease should be strongly emphasized. A 68-year-old female patient presented to the Emergency Room with confusion, lethargy, nausea and vomiting. Examination disclosed normal vital signs. Neurological examination revealed a minimally responsive woman without apparent focal deficits and normal reflexes. She had no history of hematologic disorders or alcohol abuse. Her brain TC did not demonstrate any intracranial abnormalities and electroencephalography did not reveal any subclinical epileptiform discharges. Her ammonia level was > 400 mg/dL (reference range < 75 mg/dL) while hepatitis viral markers were negative. The patient was started on lactulose, rifaximin and low-protein diet. On the basis of the doppler ultrasound and abdomen computed tomography angiography findings, the decision was made to attempt portal venography which confirmed the presence of a giant portal-systemic venous shunt. Therefore, mechanic obliteration of shunt by interventional radiology was performed. As a consequence, mesenteric venous blood returned to hepatopetally flow into the liver, metabolic detoxification of ammonia increased and hepatic encephalopathy subsided. It is crucial that physicians immediately recognize the presence of non-cirrhotic encephalopathy, in view of the potential therapeutic resolution after accurate diagnosis and appropriate treatments.
AB - Hepatic encephalopathy is suspected in non-cirrhotic cases of encephalopathy because the symptoms are accompanied by hyperammonaemia. Some cases have been misdiagnosed as psychiatric diseases and consequently patients hospitalized in psychiatric institutions or geriatric facilities. Therefore, the importance of accurate diagnosis of this disease should be strongly emphasized. A 68-year-old female patient presented to the Emergency Room with confusion, lethargy, nausea and vomiting. Examination disclosed normal vital signs. Neurological examination revealed a minimally responsive woman without apparent focal deficits and normal reflexes. She had no history of hematologic disorders or alcohol abuse. Her brain TC did not demonstrate any intracranial abnormalities and electroencephalography did not reveal any subclinical epileptiform discharges. Her ammonia level was > 400 mg/dL (reference range < 75 mg/dL) while hepatitis viral markers were negative. The patient was started on lactulose, rifaximin and low-protein diet. On the basis of the doppler ultrasound and abdomen computed tomography angiography findings, the decision was made to attempt portal venography which confirmed the presence of a giant portal-systemic venous shunt. Therefore, mechanic obliteration of shunt by interventional radiology was performed. As a consequence, mesenteric venous blood returned to hepatopetally flow into the liver, metabolic detoxification of ammonia increased and hepatic encephalopathy subsided. It is crucial that physicians immediately recognize the presence of non-cirrhotic encephalopathy, in view of the potential therapeutic resolution after accurate diagnosis and appropriate treatments.
KW - Encephalopathy
KW - Hyperammonaemia
KW - Interventional radiology
KW - Mechanical embolization
KW - Non-cirrhotic patient
KW - Portosystemic shunt
UR - http://www.scopus.com/inward/record.url?scp=85039798143&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85039798143&partnerID=8YFLogxK
U2 - 10.3748/wjg.v23.i47.8426
DO - 10.3748/wjg.v23.i47.8426
M3 - Article
AN - SCOPUS:85039798143
VL - 23
SP - 8426
EP - 8431
JO - World Journal of Gastroenterology
JF - World Journal of Gastroenterology
SN - 1007-9327
IS - 47
ER -