Treatment of Hepatic Encephalopathy by Surgical Exclusion of the Colon

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Abstract
NEUROPSYCHIATRIC disorders associated with liver disease have been under intensive clinical and laboratory investigation for the past decade. The precise causes and metabolic aberrations responsible for these syndromes are not completely understood. Exclusion or removal of the colon has a favorable effect on this disorder in properly selected patients. This case report confirms the work of McDermott and others1-3 and emphasizes the reversibility of this progressive and ultimately fatal disorder. Report of a Case The medical history of the patient, age 65, is outlined in Table 1. Following portacaval shunting the patient did rather well and was discharged on a 70-gm protein diet and a regimen of neomycin sulfate, 0.25 gm orally four times daily. He was readmitted two months postoperatively in mild coma with a history of omitting neomycin for five days. Clinically he showed slurring of speech, a staggering gait, loss of ability to feed himself or

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