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

A 67-year-old woman was admitted to our institution for hepatic encephalopathy. Careful examination revealed a large gastrorenal shunt. On an occlusion test of the gastrorenal shunt using a balloon catheter, portal vein pressure increased to as high as 26 cm H2O from the pretest value of 17.5 cm H2O. From the significant increase of portal vein pressure, it was thought that simple closure of the shunt could cause postoperative formation of an esophageal varix and its rupture. We thus performed shunt closure with distal splenorenal 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 gastric disconnection in addition to shunt closure if a remarkable increase of portal vein pressure is observed by the shunt occlusion test.