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Samuel B. Picone, Jr, MD; Arthur J. Donovan, MD; Albert E. Yellin, MD

Arch Surg. 1983;118(1):33-37.

Abstract
• Chronic portal-systemic encephalopathy (CPSE) following portal-systemic shunts may be incapacitating and nonresponsive 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.

(Arch Surg 1983;118:33-37)

Author Affiliations
From the Departments of Surgery, Los Angeles County—University of Southern California Medical Center and the University of Southern California School of Medicine, Los Angeles.

Footnotes
Accepted for publication June 24, 1982.

Read before the annual meeting of the California Chapter of the American College of Surgeons, Newport Beach, Calif, Jan 24, 1982.

Reprint requests to Department of Surgery, Los Angeles County—University of Southern California Medical Center, 1200 N State St, Los Angeles, CA 90033 (Dr Yellin).

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