![]() More than 23 months have passed since the B-RTO therapy, and no symptoms of encephalopathy have been observed yet. The patient often complained of drug-induced constipation therefore, an increase in the intra-abdominal pressure in addition to ammonia production in the intestinal tract was suspected as the cause of encephalopathy. As a result, hyperammonemia resolved immediately, and the level of ammonia was maintained at approximately 60 μg/dl. Balloon-occluded retrograde transvenous obliteration (B-RTO) was performed on the shunt. Consciousness improved with conservative treatment, whereas hyperammonemia remained. No change in the shunt diameter was noted. On admission, disturbed consciousness and an elevated serum ammonia level (221 μg/dl) were observed. It was considered that hepatic encephalopathy was caused by an increase in the ammonia level in the blood flow of the shunt, which had been diagnosed 7 years previously between the splenic vein and the left renal vein. Approximately 1 month before admission, she occasionally had a discrepant conversation. We report a case of chronic portal-systemic shunt encephalopathy in a 79-year-old female hemodialysis patient with end-stage renal disease. ![]()
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