Surgical closure of the gastrorenal shunt with distal splenorenal shunt operation for portosystemic encephalopathy

A 67-year-old woman was admitted to our institution hepatic encephalopathy. Careful examination revealed a large gastrorenal shunt. On an occlusion te st of the gastrorenal shunt using a balloon catheter, portal vein pressure increased to as high as 26cm H2O from the pretest value of 17.5cm H2O. From the significant increase of portal vein pressure, it thought that simp le closure of the shunt could cause postoperative formation of an esophagea l varix and its rupture. We thus performed shunt closure with distal spleno renal shunt with splenopancreatic and gastric disconnection to prevent the hazard. In treating the encephalopathy caused by a spontaneous shunt, it is one of the options to perform distal splenorenal shunt with splenopancreatic and g astric disconnection in addition to shunt closure if a remarkable increase of portal vein pressure is observed by the shunt occlusion test.