title: [A case of hepatic encephalopathy successfully treated by antegrade glycerin enema through percutaneous endoscopic cecostomy].
abstract: A 76-year-old man with liver cirrhosis, a chronic defecation disorder and a refractory hepatic encephalopathy was hospitalized for the hepatic encephalopathy. The encephalopathy quickly improved upon treatment, but a high level of serum ammonia persisted. We inserted a percutaneous endoscopic cecostomy at the cecum and an antegrade glycerin enema through it to treat the chronic defecation disorder, which was a deteriorative factor of the hepatic encephalopathy. After the aforementioned procedure, the chronic defecation disorder improved and the serum ammonia level dramatically decreased. The patient continued the antegrade glycerin enema at home, and serum ammonia values remained low in comparison to levels measured prior to the administration of treatment. The subject has not experienced a recurrence of hepatic encephalopathy.
authors.affiliation: Digestive Disease Center, Kohoku General Hospital.
authors.forename: Koichi
authors.initials: K
authors.lastname: Tomikashi
authors.forename: Yuh
authors.initials: Y
authors.lastname: Nomura
authors.forename: Kiichiro
authors.initials: K
authors.lastname: Miyawaki
authors.forename: Ayumi
authors.initials: A
authors.lastname: Shimada
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kanemitsu
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Takashima
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Abe
mesh_terms: D000368:Aged; D000641:Ammonia / Q000097:blood; D002431:Cecostomy / Q000379:methods*; D003248:Constipation / Q000150:complications / Q000628:therapy; D016099:Endoscopy, Gastrointestinal; D004733:Enema; D005990:Glycerol / Q000008:administration & dosage*; D006501:Hepatic Encephalopathy / Q000628:therapy*; D006801:Humans; D008297:Male
chemical_list: D000641:Ammonia; D005990:Glycerol