Colectomy for Porto-Systemic Encephalopathy: Is it Still Topical?

Area of Science:

• Gastroenterology and Hepatology
• Surgical Gastroenterology

Background:

• Hepatic encephalopathy (HE) is a frequent long-term complication following porto-systemic shunt procedures.
• Porto-systemic shunts, while effective for variceal bleeding, can lead to refractory HE due to increased ammonia levels.

Observation:

• A 59-year-old male with Child-Pugh A cirrhosis, previously treated with a distal splenorenal shunt, developed severe, medically refractory HE.
• Liver transplantation was not an immediate option, and shunt obliteration posed significant risks.

Findings:

• Subtotal colectomy was performed to decrease intestinal ammonia production.
• This surgical intervention resulted in a significant reduction in the grade of HE and overall patient improvement.

Implications:

• Colonic exclusion represents a viable therapeutic option for refractory HE in select patients.
• This approach may serve as a bridge therapy for patients awaiting liver transplantation.