SUCCESSFUL SURGICAL-TREATMENT FOR HEPATIC-ENCEPHALOPATHY CAUSED BY A PANCREATIC SIPHON - REPORT OF A CASE

We report herein the case of a 39-year-old man with cirrhosis of the l iver who developed hepatic encephalopathy and progressive diabetes cau sed by a pancreatic siphon after undergoing a distal splenorenal shunt (DSRS) for a variceal hemorrhage. Radiologic occlusion was judged to be inappropriate because of the extensive DSRS. The DSRS was surgicall y closed 6 years after the operation to restore portal perfusion. To a lleviate the portal hypertension, splenectomy and gastric devasculariz ation were performed, which proved successful, as the encephalopathy d isappeared completely, the ammonia levels decreased, liver function im proved, and the diabetes subsided. Our experience indicates that a sma ll percentage of cirrhotic patients who undergo DSRS with longterm fol lowup may develop various undesirable complications, although some of these patients benefit from a combination of surgical shunt occlusion, splenectomy, and gastric devascularization.