Abdominal colectomy for chronic encephalopathy due to portal-systemic shunt

Chronic portal-systemic encephalopathy (CPSE) following portal-systemic shunts may be incapacitating and non-responsive to intensive medical management. Between 1960 and 1980, 12 patients with cirrhosis who were institutionalized with CPSE underwent colonic exclusion. Cirrhosis was due to alcohol in ten patients and to cryptogenic liver disease in two. Nine patients had previously undergone end-to-side portacaval shunts and two patients had had mesocaval shunts. One patient had a spontaneous shunt between splenic and renal veins. Ten patients underwent colectomy and ileosigmoidostomy; one had colectomy, ileostomy, and mucous fistula; and one had colonic bypass and ileosigmoidostomy. Four patients died postoperatively. Survivors were clinically improved and able to leave a closed institutional environment. Colectomy may be considered in disabling cases of CPSE unresponsive to medical therapy; it is a final effort at functional rehabilitation. Although mortality is high, improvement in functional status can be expected among survivors of the operation.