肝性昏睡を反復した特発性門脈圧亢進症の1例

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A 31 year old female was diagnosed as the idiopathic portal hypertension with esophageal varices and esophageal transection was carried out. One year and 4 months later, portal thrombosis took place and near total intestinal resection was obliged. Thereafter mental disturbance was occasionally observed and 7 months later the patient fell into III grade hepatic coma, which was treated successfully by administration of lactulose and branched chain amino acid solution. Portal obstruction accompanied with hepatopetal collaterals was revealed by superior mesenteric arteriography and induction of coma was easily achieved by the oral administration of a large amount of protein. It is presumed that the encephalopathy was produced by the increased concentration of ammonia and amino acids at first in the portal vein due to the reduction of portal blood flow and accordingly in the systemic circulation due to the existence of highly developed portal-systemic collaterals.
社団法人日本肝臓学会の論文