A Controlled Trial of Colon Bypass in Chronic Hepatic Encephalopathy

Resnick, Robert H.; Ishihara, Albert M.; Chalmers, Thomas C.; Schimmel, Elihu M.

doi:10.1016/s0016-5085(68)80126-x

Cited by 98 publications

(16 citation statements)

References 16 publications

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“…Regardless of the mechanism involved, the fact that a colectomy induces a regenerative pattern of IEP gene expression in the liver similar to that observed following PHx warrants a reevaluation of previous reports documenting the beneficial effects of colectomy on hepatic encephalopathy in patients with advanced liver disease (16,17). Specifically, in light of the present findings, it is conceivable that the improvements in mental status of these patients might not have been derived solely from changes in plasma ammonia and/or other encephalopathogenic factors but, rather, improved hepatic function derived from increased regenerative activity.…”

Section: Discussionmentioning

confidence: 85%

The Effects of Colectomy on Immediate–Early Proto-Oncogene Expression and Hepatic Regeneration in the Rat

et al. 2006

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The intact liver exists in a state of replicative quiescence. The factor(s) responsible for maintaining this state and their tissue sources have yet to be identified. Because the colon synthesizes and/or absorbs numerous agents that inhibit hepatocyte proliferation, the principle purpose of this study was to determine whether total colectomy would result in the conversion of quiescent livers to a state of replicative competence. Thus, adult, male Sprague-Dawley rats (250-300 g) were randomized to undergo either total colectomy with ileostomy or sham surgery. Thereafter, rats were sacrificed (N=3-6/group) at times 15 and 30 min and 1, 2, 6, and 24 hr and the livers analyzed by Northern blot analyses for mRNA of the following immediate-early proto-oncogenes (IEP genes): c-fos, c-jun, and c-myc. Rats sacrificed at 24 hr also had hepatic regenerative activity documented by [3H]thymidine incorporation into hepatic DNA. The results of the study revealed that within 15 min, c-fos and c-jun mRNA expression increased in colectomized rats, with peak expression occurring at 30 and 60 min, respectively. c-myc mRNA expression was more delayed, with peak expression occurring at 6 hr post-colectomy. IEP gene expression also increased somewhat in sham-colectomy controls but the increases were not as prompt and, in general, were of lower magnitude than those in the colectomy group. Despite the differences in IEP gene expression between the two groups, [3H]thymidine incorporation at 24 hr was similar (mean+/-SE: colectomy group, 17.2+/-2.6 dpm/microg DNA; sham-colectomy controls, 14.8+/-1.4 dpm/microg DNA). To determine whether the increases in IEP gene expression expedite or augment the hepatic regenerative response to partial hepatectomy (PHx), rats that had undergone colectomy or sham colectomy 1 hr earlier and rats with no previous abdominal surgery then underwent a 70% PHx and were sacrificed at 8, 16, and 24 hr thereafter. At each time interval, [3H]thymidine incorporation was documented and found to be similar in the three groups. In conclusion, the results of this study indicate that total colectomy, and to a lesser extent abdominal surgery, induces the conversion of an intact, quiescent liver to a state of replicative competence. The results also suggest that, in addition to colectomy, the presence of mitogens and/or co-mitogens is required for further progression of hepatocytes through the cell cycle. Finally, a "primed" liver does not respond more promptly or vigorously to a regenerative stimulus than a "resting" liver.

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Section: Discussionmentioning

confidence: 85%

The Effects of Colectomy on Immediate–Early Proto-Oncogene Expression and Hepatic Regeneration in the Rat

et al. 2006

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“…In 1968, Resnik et al 13 were the first to describe peristomal varices in the literature when three patients suffered from stomal haemorrhaging after developing ileostomy varices. Since then, various management options have been described in the literature with varying outcomes.…”

Section: Discussionmentioning

confidence: 99%

Bleeding from peristomal varices: a complication of portal hypertension

Khan

Vessal²,

Gordon-Williams³

2011

Case Reports

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SummaryPeristomal varices are a recognised complication of stomas in the presence of portal hypertension. There has been a progression of treatment options described in the literature, including the transjugular intrahepatic portosystemic shunt (TIPS). The use of TIPS, a percutaneous procedure allowing connection between the portal and systemic circulations within the liver, is a well-recognised method of treating the complications of portal hypertension. This report presents a case of peristomal varices successfully treated with TIPS and subsequently reviews the literature relating to its management.

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“…Since the original description by Resnick et al (9) in 1968, fewer than 100 cases have been reported (6, 7), and fewer than 20 patients with stomal variceal bleeding have been treated with TIPS in the English literature (2, 10-12). …”

Section: Discussionmentioning

confidence: 99%

A Case of Successful Treatment of Stomal Variceal Bleeding with Transjugular Intrahepatic Portosystemic Shunt and Coil Embolization

Han

Cho

et al. 2007

J Korean Med Sci

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Variceal bleeding from enterostomy site is an unusual complication of portal hypertension. The bleeding, however, is often recurrent and may be fatal. The hemorrhage can be managed with local measures in most patients, but when these fail, surgical interventions or portosystemic shunt may be required. Herein, we report a case in which recurrent bleeding from stomal varices, developed after a colectomy for rectal cancer, was successfully treated by placement of transjugular intrahepatic portosystemic shunt (TIPS) with coil embolization. Although several treatment options are available for this entity, we consider that TIPS with coil embolization offers minimally invasive and definitive treatment.

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A Controlled Trial of Colon Bypass in Chronic Hepatic Encephalopathy

Cited by 98 publications

References 16 publications

The Effects of Colectomy on Immediate–Early Proto-Oncogene Expression and Hepatic Regeneration in the Rat

The Effects of Colectomy on Immediate–Early Proto-Oncogene Expression and Hepatic Regeneration in the Rat

Bleeding from peristomal varices: a complication of portal hypertension

A Case of Successful Treatment of Stomal Variceal Bleeding with Transjugular Intrahepatic Portosystemic Shunt and Coil Embolization

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