Treatment of Progressive Ammonia Intoxication by Exclusion of the Colon

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Abstract
A FEW cases of surgically created portal–systemic shunts and progressive ammonia intoxication that have been improved by colectomy,1 hemicolectomy2 and colonic exclusion have been reported.3 The rationale for these procedures is to eliminate the ammonia produced by the high concentration of bacteria normally present in the colon.4 , 5 The case presented below re-emphasizes the role of the colon in the elevation of blood ammonia concentration and production of neurologic signs associated with portal–systemic shunts. The following is a chronologic outline of the major events in the course of this sixty-eight-year-old woman's illness: 1947, cholecystectomy; 1957, dilatation of commonduct stricture; 1961, choledochojejunostomy, . . .