A 57-year-old @entity1 was admitted to our hospital for @entity99 . He previously had undergone a partial gastrectomy for @entity2275 , and also had been on maintenance hemodialysis because of @entity2316 . Despite treatment with branched-chain @entity1522 and lactulose, @entity75 occurred repeatedly. The findings of his laboratory examinations, computed tomography, and liver biopsy were not suggestive of chronic @entity409 . Angiography revealed a portal-systemic shunt from the superior mesenteric vein via the left gastric vein to the left renal vein. A ligation of the gastrorenal shunt was performed. After the shunt ligation, @entity99 no longer recurred, and no medication was required to prevent it. The insulin requirements also decreased, the plasma @entity3265 concentration then decreased, and serum concentration of several @entity1522 related to the @entity3265 metabolism also decreased. The molar ratio of branched-chain @entity1522 to aromatic @entity1522 increased. The ligation of the portal-systemic shunt was thus considered to be the key to the successful treatment of @entity99 in this unusual case.

Recurring XXXX abolished by gastrorenal shunt ligation in a diabetic hemodialysis @entity1 .

@entity1 :: ('9606', 'Species') :: ['man'] @entity1522 :: ('CHEBI:33709', 'Chemical') :: ['amino acids'] @entity3265 :: ('MESH:D000641', 'Chemical') :: ['ammonia'] @entity2316 :: ('MESH:D003928', 'Disease') :: ['diabetic nephropathy'] @entity75 :: ('MESH:D001927', 'Disease') :: ['encephalopathy'] @entity409 :: ('MESH:D008107', 'Disease') :: ['liver damage'] @entity99 :: ('MESH:D056486', 'Disease') :: ['hepatic encephalopathy'] @entity2275 :: ('MESH:D013276', 'Disease') :: ['gastric ulcer']
@entity75 :: (MESH:D001927,Disease) :: ['encephalopathy']
