Surgery for gastric cancer in a patient with non-cirrhotic hyperammonemia: a case report

We report a case of gastric cancer in a patient with non-cirrhotic hyperammonemia secondary to a spontaneous portacaval shunt. The patient, a 69-year-old male, had more than 40 years of abdominal discomfort. On gastroscopy, 2.0 × 1.5-cm irregular uplift ulcers were seen on the lesser curvature of the stomach, and tissue biopsy revealed poorly differentiated adenocarcinoma. His hyperammonemia was found on celiac angiography to be due to the formation of a spontaneous portacaval shunt. Imaging revealed no evidence of cirrhosis or portal hypertension. The patient ultimately underwent a distal gastrectomy and gastroduodenal anastomosis; the spontaneous portacaval shunt was left untreated. Postoperatively, there were no short-term complications such as anastomotic leakage, stricture, or bleeding, and the patient's blood ammonia level decreased to within the normal range. Radical gastrectomy without splenectomy or closure of the abnormal shunt was feasible for the treatment of gastric cancer in a patient with non-cirrhotic hyperammonemia.