We presented a case of chronic recurrent hepatic encephalopathy occurring in a liver cirrhosis patient (Child Pugh A) with a large gastrorenal shunt and a review of the literature focusing on diagnosis and management. Computed tomography (CT) demonstrated an atrophic liver, splenomegaly, varices at the gastric fundic and the splenic hilum, and a highly tortuous shunt vessel between the gastric fundic varices and the left renal vein. Ultrasonography revealed the portal vein diameter was 0.8 cm; and portal vein blood flow velocity was 17.6 mL/s. In practice, the clinician need to ascertain the existence of the large portosystemic shunt when the patients presenting hepatic encephalopathy recurrent or refractory to standard medical treatments.
