Abstract
A method of shunting the abdominal cavity and vena cava superior developed by Leveen has been employed of late in a more active treatment of patients with intractable ascites. When we treated patients Who had hepatitic cirrhosis with Leveen's method of shunting the abdominal cavity and vena cava superior a transient hepatic encephalopathy developed after treatment.
In an attempt to clarify the cause of this developement, we compared both the serum and ascitic ammonium values obtained from 18 cases of hepatitic cirrhosis accompanied with ascites, and found out that the ascitic ammonium values in 15 cases (83%) were higher than that of blood.
In contrast to the group with hepatitic cirrhosis, when the serum and ascitic ammonium values obtained from 7 control patients with non-hepatitic cirrhotic diseases such as peritonitis carcinomatosa were studies, 5 out of 7 cases (71%) showed higher values of serum ammonium than that of asities.
On the other hand, it has long been known among medical workers that hepatic encephalopathy could be induced when a voluminous diuresis is obtained at one time or removed in a pathient with hepatitic cirrhosis accompanied with asities and that it is conceivaly attributable to abnomal electrolytes including other factors. However, the results obtained from our current investigations have suggested that when a voluminous ascites is perfused with blood at on time, the ascitic ammonium comes into the blood because of its having a higher value than that of blood, thereby raising up the ammonium value of the blood which may cause hepatic encephalopathy.
