Prospective study of portasystemic encephalopathy after emergency portacaval shunt for bleeding varices

American Journal of Surgery
R H BellM J Orloff

Abstract

A prospective study of the development of encephalopathy was undertaken in 180 patients undergoing emergency portacaval shunt for bleeding esophageal varices between 1963 and 1978. The incidence of preoperative encephalopathy was 32 percent. Postoperatively, encephalopathy developed in 31.5 percent of 95 survivors and was severe in 7 percent of those survivors. Encephalopathy developed in most patients in the first and second follow-up years; in 10 year survivors, encephalopathy was virtually absent. Encephalopathy was more likely to occur in patients with encephalopathy at the time of shunt and in those who returned to alcoholism after shunt. Most encephalopathic episodes were precipitated by dietary indiscretion, often associated with alcoholism. Careful follow-up with attention to dietary compliance and abstinence from alcohol should make the risk of encephalopathy acceptable in relation to the unquestionable benefits of portacaval shunt in reducing the risk of variceal hemorrhage.

Citations

Jan 1, 1996·Cardiovascular and Interventional Radiology·J S HsiehT J Huang
May 1, 1983·Annals of Surgery·J G Chandler, R E Fechner
Sep 10, 1983·British Medical Journal·P C HayesI A Bouchier
Jul 1, 1985·American Journal of Surgery·M B DurtschiK H Johansen
Oct 1, 1994·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·M J OrloffA G Greenburg
Aug 1, 1986·The British Journal of Surgery·K Peterson, G R Giles
Nov 1, 1988·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·G Pomier-LayrarguesP Lavoie
Oct 1, 1984·World Journal of Surgery·A D Callow

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