We present a 70-year-old male on chronic hemodialysis who developed portal-systemic shunt encephalopathy.
The patient has undergone maintenance hemodialysis at our hospital due to diabetic nephropathy since April 2000. On February 26, 2001, he consulted our hospital with complaint of disorientation, somnolence and loss of consciousness. On emergency admission, laboratory data demonstrated a venous blood ammonia level of 282μg/dL (normal: less than 75μg/dL). Abdominal enhanced CT and angiography demonstrated a gastro-renal shunt. Balloon-occluded retrograde transvenous obliteration and drug therapy were performed. Neuropsychological symptom recovered after drug therapy and the venous blood ammonia level was normalized after the obliteration. During a 17-month follow-up, there has been no recurrence of encephalopathy.