CHRONIC HEPATIC-ENCEPHALOPATHY FOLLOWING PORTACAVAL-SHUNT - MANAGEMENT BY LOOP ILEOSTOMY

A 69 year old woman developed intractable episodic hepatic encephalopa thy 12 years after an end-to-side portacaval shunt for variceal haemor rhage. Medical management was ineffective in preventing repeated episo des of encephalopathy and caused incapacitating faecal incontinence. A loop ileostomy was created with minimal morbidity and was effective i n preventing further episodes of encephalopathy over a follow-up perio d of 33 months. The patient returned to a normal diet and was able to be discharged home from institutional care. Loop ileostomy is an alter native in the management of patients with hepatic encephalopathy who a re poorly responsive to, and/or intolerant of, medical therapy followi ng portasystemic shunt surgery.