title: Incisional hernia as an unusual cause of hepatic encephalopathy in a 62-year-old man with cirrhosis: a case report.
abstract: BACKGROUND
  Hepatic encephalopathy may be initiated by many factors such as gastrointestinal bleeding, infections, fluid and electrolyte disturbances. Hypokalemia is one of the most commonly encountered electrolyte abnormalities causing hepatic encephalopathy in patients with cirrhosis.
  
  
  METHODS
  We present the case of a 62-year-old Caucasian man with decompensated liver cirrhosis having multiple episodes of hepatic encephalopathy precipitated by vomiting. He had an incisional hernia at the right lumbar region. A barium contrast study of the small intestine and magnetic resonance imaging showed that the hernial sac included gastric antrum and bowel. We observed that hepatic encephalopathy coincided with hypokalemia as a result of a large volume of vomiting triggered by the collapsed hernial sac. Hepatic encephalopathy was resolved by administration of intravenous potassium.
  
  
  CONCLUSIONS
  This case illustrates that a hernia causing a large volume of vomiting may be a precipitant factor in the development of hepatic encephalopathy.
authors.forename: Muge
authors.initials: M
authors.lastname: Ustaoglu
authors.forename: Tulay
authors.initials: T
authors.lastname: Bakir
authors.forename: Ahmet
authors.initials: A
authors.lastname: Bektas
authors.forename: Osman
authors.initials: O
authors.lastname: Cure
authors.forename: Bulent
authors.initials: B
authors.lastname: Gungor