April 9, 1982

Encephalopathy Following Jejunoileostomy-Reply

Author Affiliations

Highland Hospital Rochester, NY

JAMA. 1982;247(14):1939. doi:10.1001/jama.1982.03320390022026

In Reply.—  The suggestion by Drs Finestone and Chowdhury concerning the possible etiology of the encephalopathy that we have observed after jejunoileostomy is of interest to us. The possibility that the syndrome is related to portal vein thrombosis, however, would seem relatively remote. We can speak with some assurance about the two patients who underwent surgery to reverse the jejunoileostomy. Neither of these showed evidence of portal vein thrombosis at operation. In the other patients we can only point out that there was no evidence of collateral circulation apparent externally, and some of the physical signs usually associated with hepatic encephalopathy were not present. There was no flapping tremor, cogwheel rigidity, or sustained clonus, and the plantar reflexes were normal. In addition, the occurrence of encephalopathy was not associated with the usual precipitory factors in hepatic coma.1Perhaps more convincing is the fact that one patient (No. 7) underwent