J.Jpn. Surg. Soc.. 59(9): 1443-1460, 1958

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STUDY ON THE AMMONIA METABOLISM IN THE SURGERY FOR PORTAL HYPERTENSION

From the view of blood ammonia metabolism, several surgical procedures for reIief of portal hypertension have been studied both experimentally and clinically through the estimation of blood ammonia concentration in the peripheral and organic circulation and ammonia tolerance test. Relationship between the Eck fistula syndrome and ammonia metabolism has also discussed.
The results obtained from the study are as follows :
1. Hepatic vein, peripheral vein and portal vein concentration of ammonia in the patients with Banti's syndrome were remarkably elevated as compares to those in the normal subjects.
Ammonia tolerance test shows that the maximum concentration of blood ammonia in the patients with Banti's syndrome is at higher level than normal subjects and remains elevated for prolonged period of time.
2. In a review of ammonia metabolism following the several surgical procedures on the patients with portal hypertension, the lowest concentration of ammonia was noted in the patients with splenectomy and portal thrombectomy, which showed rather lower concentration of blood ammonia than that of the preoperative levels.
Of the shunt operation combined with splenectomy, the long term follow-up study revealed that the lowest ammonia concentration was obtained by the method of portal arterialization, and by the procedure of intrahepatic omentopexy.
Increased ammonia level was noticed in most of the cases with side-to-side and end-to-side portacaval anastrmosis. The Eck fisula syndrome were found not infrequently in the patients with end-to-side portacaval anastomosis.
Experimental study on the ammonia metabolism and ammonia tolerance test revealed that the lowest ammonia content of blood was noted in the dogs with end-to-side portacaval anastomosis, combined with portal arterialization. The cases with end-to-side portacaval anastomosis combined with intrahepatic arterial implantation revealed also the lower level of blood ammonia.
The procedure of end-to-side poracaval anastomosis combined with intrahepatic omentopexy presented no definite effect upon the ammonia metasbolism as well as that of side-to-side portacaval anastomosis.
The most increased level of peripheral blood ammonia was noted in the dogs with end-to-side portacaval anastomosis followed by no additional shunt operation.
3. The postoperative occurrence of Eck fistula syndrome were found most frequently in the patients with end-to-side portacaval anastomosis followed by no additional shunt operation (23.5%). Two of four patients with Eck fistula syndrome succumbed. Follow-up study of the patients revealed that they frequently develop the sizure of Eel fistula syndrome with marked elevation of blood ammonia level which rise over 300 ug/dl.
(author's abstract)

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