Surgical treatment of a patient with idiopathic portal hypertension and hepatic encephalopathy

Idiopathic portal hypertension is clinically characterized by splenomegaly and portal hypertension. Hepatic encephalopathy is rare in cases with idiop athic portal hypertension. In a 59-year-old man with recurrent hepatic ence phalopathy for one year, a large splenorenal shunt was detected in the comp uted tomography and angiography, and liver biopsy revealed a portal fibrosi s consistent with idiopathic portal hypertension. Devascularization of the upper stomach, splenectomy and closure of the splenorenal shunt were done. The patient has had no experience of encephalopathy since the operation eve n without drug treatment. Surgery should be considered for treatment of chr onic hepatic encephalopathy in patients with idiopathic portal hypertension and portosystemic shunts.