Colectomy for Porto-Systemic Encephalopathy: Is it Still Topical?
Hepatic encephalopathy (HE) is a common long term complication of porto-systemic shunt. We report herein the case of a 59-year-old man with Child-Pugh A cirrhosis treated successfully 9 years earlier with distal splenorenal shunt for uncontrolled variceal bleeding. In the last year, he developed a severe and persistent hepatic encephalopathy secondary to the shunt, which was resistant to medical therapy. As liver transplantation was not available and obliteration of the shunt was hazardous, we performed subtotal colectomy in order to reduce ammonia production. This therapeutic option proved successful, as the grade of encephalopathy decreased and the patient improved. Our experience indicates that colonic exclusion should be considered as an option in the management of HE refractory to medical treatment in highly selected patients when liver transplantation is not available or even as a bridge given the long waiting time on lists.
Department of Hepato-gastro-enterology.
Rym
R
Ennaifer
Department of Hepato-gastro-enterology.
Romdhane
R
Hayfa
Department of Hepato-gastro-enterology.
Rania
R
Hefaiedh
Department of Surgery, Mongi Slim Universitary Hospital , Tunis, Tunisia.
Lobna
L
Marsaoui
Department of Hepato-gastro-enterology.
Najet Bel
NB
Hadj
Department of Surgery, Mongi Slim Universitary Hospital , Tunis, Tunisia.
Tahar
T
Khalfallah
ammonia; colectomy; distal splenorenal shunt; hepatic encephalopathy; porto-systemic shunt