Liver resection for a congenital intrahepatic portosystemic shunt in a child with hyperammonemia and hypermanganesemia: a case report

Background Congenital portosystemic shunt (CPSS) is a rare malformation that leads to hyperammonemia, hypermanganesemia, and various symptoms. CPSSs are divided into intrahepatic and extrahepatic shunts. In patients with persistent CPSS including an intrahepatic portosystemic shunt (IPSS), early int...

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Bibliographic Details
Published in:Surgical case reports 2020-04, Vol.6 (1), p.73-73, Article 73
Main Authors: Takama, Yuichi, Nakamura, Tetsuro, Santo, Kenji, Yoneda, Akihiro
Format: Article
Language:English
Subjects:
Age
Ammonia
Bile
Case Report
Case reports
Catheters
Congenital portosystemic shunt
Hepatectomy
Hyperammonemia
Hypermanganesemia
Intrahepatic portosystemic shunt
Liver
Liver resection
Magnetic resonance imaging
Medicine
Medicine & Public Health
Patients
Pediatric
Pediatrics
Pulmonary hypertension
Surgery
Ultrasonic imaging
Veins & arteries
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Summary:Background Congenital portosystemic shunt (CPSS) is a rare malformation that leads to hyperammonemia, hypermanganesemia, and various symptoms. CPSSs are divided into intrahepatic and extrahepatic shunts. In patients with persistent CPSS including an intrahepatic portosystemic shunt (IPSS), early intervention to occlude the shunt reverses the associated complications. Case presentation The patient was a 1-year-and-7-month-old girl. She presented with hypergalactosemia and elevation of blood ammonia level (75 μg/dL) and total bile acid levels (68.2 μmol/L) during the neonatal period. Two IPSSs were detected using ultrasound and enhanced computerized tomography. Magnetic resonance imaging (MRI) at 1 year and 3 months of age showed abnormally high signal intensity in the pallidum of her brain. Spontaneous closure was not observed. We performed a right hepatectomy at 1 year and 7 months of age. The portal vein pressure was 16 mmHg after temporary occlusion of the right portal vein. Blood ammonia and serum manganese levels decreased immediately after the operation. The abnormal signal on brain MRI disappeared. She had a favorable course with no sign of recurrence of IPSS 5 years postoperatively. Conclusion Liver resection for an IPSS to control the symptoms of a portosystemic shunt is reasonable in a child for whom interventional radiological treatment is not indicated.
ISSN:2198-7793
2198-7793
DOI:10.1186/s40792-020-00838-5