Kirin: Liver Shunt Surgery

4 months ago, a kind act by rescuer Benji and Purely Adoptions got a very sick puppy off the streets. Treatment and surgery by Dr Dennis Choi and Dr Nathalee Prakash provided the best chance for a long healthy life. Top it all off, Dr Gloria Lee and Victor changed Kirin’s future by giving him the best home any street dog could ask for!

When Kirin was found in a car workshop, he was very weak and showing signs of respiratory distress.

portosystemic or liver shunt

Our liver plays a role in most of the metabolic processes in the body. Normally, blood from the abdominal organs flows to the liver via the portal vein. The blood brings the liver nutrients and is cleansed of toxins and impurities.

In a puppy like Kirin, a portosystemic or liver shunt is an abnormal blood vessel that diverts blood around the liver instead of into it. The liver is deprived of necessary nutrients and fails to grow normally. Congenital shunts can be extrahepatic (outside the liver) or intrahepatic (inside the liver).

With Purely Adoption’s support, rescuer Benji took Kirin to Mount Pleasant Vet Centre (Mandai) for treatment.

Clinical Signs and diagnosis of Liver Shunts

Common clinical signs include stunted growth, poor muscle development, mental dullness, reduced appetite, vomiting, diarrhoea, blood in urine. Hepatic insufficiency combined with toxin build-up can result in hepatic encephalopathy – affecting the brain and causing neurological signs such as  ataxia, seizures, head pressing and behavioural changes.

Common clinical signs of liver shunts include stunted growth and mental dullness

Kirin was referred to Mount Pleasant (Gelenggang) for a full diagnostic work-up including blood work, urinalysis, liver function tests, ultrasound and CT scan with contrast to confirm and locate the portosystemic shunts.

medical management Before Surgery

Before surgery could be performed, Kirin was managed by veterinary specialist Dr Nathalee Prakash. The aim was to reduce the amount of toxins produced and improve Kirin’s health  to decrease the risk of anaesthesia and surgery. Kirin was placed on an appropriate hepatic diet, antibiotics to reduce intestinal bacterial overgrowth, and lactulose to encourage rapid transit of faecal matter and bacteria through the intestinal tract.

Kirin with veterinary specialist Dr Nathalee Prakash at Mount Pleasant (Gelenggang)

liver shunt Surgery 

Once Kirin’s condition is stable for general anaesthesia, surgeon Dr Dennis Choi performed a challenging procedure to close the shunt. The abdominal cavity is opened and the liver shunt identified. An ameroid ring constrictor is then carefully placed around the shunt, allowing it to close progressively over time and restore normal blood flow to the liver.

Gradual occlusion is important to prevent excessively high portal system pressure, called portal hypertension, which can result in death.

Dr Dennis Choi assisted by Dr Korn

After locating the shunt, Dr Dennis Choi prepares to place the ameroid ring constrictor around it.

Over the next few weeks, the casein absorbs fluids from the body and swells inwards, gradually compressing the shunt to restore normal blood flow to the liver.

Kirin was hospitalised for a few days and closely monitored

Kirin at his post-surgery review. Surgical site healing very well.

Kirin with Dr Korn, Victor, Dr Dennis Choi, Dr Gloria Lee

A month and half after surgery, Kirin is a healthy 19kg, playful and active.

post surgery care

It takes time for liver cells to regenerate and regain normal function as the shunt slowly closes in the weeks following ameroid constrictor placement.  Kirin  will continue on a hepatic diet and medications while returning for regular blood tests to monitor his recovery. Meanwhile, this sweet little boy is bright, active and happily annoying his big brother Tully — enjoy the video below!


We welcome medical stories of your animal friends to educate and inspire others. Email us at comms@mountpleasant.com.sg and be part of Mount Pleasant community over at our Website and Facebook.

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