# Hepatic Encephalopathy Induced by Small Bowel Obstruction in a Patient With Primary Biliary Cholangitis

## TL;DR

A patient with primary biliary cholangitis developed hepatic encephalopathy due to a small bowel obstruction and recovered after treatment.

## Contribution

Highlights a rare case linking small bowel obstruction to hepatic encephalopathy in primary biliary cholangitis.

## Key findings

- Hepatic encephalopathy was triggered by a small bowel obstruction in a PBC patient.
- Conservative management and targeted treatment led to neurological recovery and normalized markers.
- The case emphasizes the need to identify and address reversible causes of HE promptly.

## Abstract

Hepatic encephalopathy (HE) represents a spectrum of neuropsychiatric abnormalities resulting from hepatic dysfunction. This case report discusses the case of a 66-year-old woman with a known diagnosis of primary biliary cholangitis (PBC) who presented with a 10-day history of constipation, vomiting, and progressive cognitive decline. Cross-sectional imaging of the abdomen revealed a large ventral hernia in the anterior midline containing multiple loops of small bowel, consistent with adhesional small bowel obstruction. Laboratory investigations demonstrated elevated ammonia levels and deranged liver function tests (LFTs), consistent with the clinical picture of HE. The patient was managed conservatively with bowel decompression, and HE was successfully treated with rifaximin and, following the resolution of the obstruction, with lactulose. The patient made a good neurological recovery with normalization of biochemical markers and was discharged from the intensive care unit (ICU) in a stable condition. This case underscores the importance of recognizing and promptly addressing reversible precipitants of HE and illustrates the challenges of managing HE in the context of gastrointestinal obstruction.