RECURRENT HEPATIC PRE-COMA RESULTING FROM A SPONTANEOUS PORTO-SPLENO-RENAL SHUNT (PSRS)

A 64-year-old Turkish male is described with recurrent hepatitic (pre- )coma resulting from a spontaneous porto-spleno-renal shunt, portal hy pertension and hepatic insufficiency. In cases of chronic encephalopat hy resulting from hepatic insufficiency that may be due to liver cirrh osis, the presence of a spontaneous porto-spleno-renal shunt should be considered as a distinct possibility, not only in the absence of appa rent oesophageal varices and splenomegaly, but also when there is hepa topetal flow in the portal vein.