Hyperammoniemic coma in a patient with ureterosigmoidostomy and normal liver function.

Area of Science:

• Nephrology
• Gastroenterology
• Neurology

Background:

• Ureterosigmoidostomy is a surgical procedure that connects the ureters to the sigmoid colon.
• Hyperammoniemic encephalopathy is a serious neurological complication characterized by elevated ammonia levels in the blood.
• Bacterial overgrowth and liver dysfunction are commonly associated with hyperammoniemic encephalopathy post-ureterosigmoidostomy.

Observation:

• A 43-year-old woman with a 28-year-old ureterosigmoidostomy presented with hyperammoniemic coma.
• The patient experienced acute rectocolitis, a severe inflammation of the rectum and colon.
• No underlying liver dysfunction was detected in this patient.

Findings:

• Standard treatments like lactilol, neomycin, and rectal tube drainage were ineffective.
• Systemic antimicrobial therapy targeting urease-producing gram-negative bacilli was administered.
• The antimicrobial treatment led to a significant reduction in serum ammonia levels and clinical improvement.

Implications:

• This case demonstrates that hyperammoniemic encephalopathy can occur after ureterosigmoidostomy even without liver dysfunction.
• Effective management relies on identifying and treating the underlying bacterial overgrowth with appropriate antibiotics.
• Prompt diagnosis and targeted antimicrobial therapy are crucial for favorable outcomes in such cases.