Two cases of Inose-type hepatic encephalopathy successfully treated with shunt resection

An Inose-type hepatic encephalopathy due to a porto-systemic shunt was successfully treated by resection of the shunt. Patient 1, 71-year-old man with normal liver, was presented with hepatic encephalopathy after the operation of diffuse peritonitis with strangulated ileus. Computed tomography revealed the presence of a large spleno-renal shunt. We ligated and divided the splenorenal shunt during an open surgery. Patient 2 was a 79-year-old man with hepatitis C. Computed tomography showed the large shunt from superior mesenteric vein to inferior vena cava. The shunt resection was performed. Portal thrombosis developed after the operation but anti-coagulant therapy was effective. No evidence of hepatic encephalopathy in this two patients occurred after the operation. For the treatment of porto-systemic shunt resection is available but caution must be exercised for liver cirrhosis, esophageal varix and portal thrombosis.