Hepatic Encephalopathy Precipitated by Fecal Impaction

Two episodes of hepatic encephalopathy developed in a 64-year-old man with cirrhosis during the course of hospitalization. The first event was precipitated by spontaneous bacterial peritonitis; the second occurred four weeks later and was associated with a massive fecal impaction, an unreported precipitant. No other potential causes were demonstrated. Symptoms promptly resolved following disimpaction.