D. P. STABLES, M.B.; B. LEVIN, M.B., B.CH.; G. A. ELLIOTT, M.D., F.R.C.P.; D. J. DUPLESSIS, CH.M., F.R.C.S.
The surgical relief of portal hypertension by portacaval anastomosis confers freedom from life-threatening hemorrhage in the majority of instances, but the risk of subsequent neurological and psychiatric change is high. Few patients regain their previous intellectual ability (1), and 18 (2) to 33% (1) experience recognizable attacks of portal-systemic encephalopathy. Conventional therapy with limited protein intake, oral antibiotics, and regular purgation will control or prevent most of these episodes, but a number of patients are intellectually crippled by chronic encephalopathy. A few have been reclaimed by removal or exclusion of the colon, the major source of ammonia production in the
STABLES DP, LEVIN B, ELLIOTT GA, DUPLESSIS DJ. Colonic Exclusion for Chronic Portal-Systemic Encephalomyelopathy. Ann Intern Med. ;65:326–329. doi: 10.7326/0003-4819-65-2-326
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Published: Ann Intern Med. 1966;65(2):326-329.
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