Acute ammonia intoxication 37 years after ureterosigmoidostomy

Area of Science:

• Nephrology
• Neurology
• Gastroenterology

Background:

• Ureterosigmoidostomy is a surgical procedure connecting the ureters to the sigmoid colon.
• This procedure can lead to complications such as hyperammonemia, particularly when hepatic disease is present.
• Hyperammonemia can precipitate metabolic encephalopathy, potentially leading to coma.

Observation:

• A rare case of acute hyperammonemic encephalopathy is presented.
• The patient developed symptoms 37 years after undergoing ureterosigmoidostomy.
• Clinical and electroencephalographic resolution was achieved with oral neomycin therapy.

Findings:

• The study highlights a delayed onset of hyperammonemic encephalopathy following ureterosigmoidostomy.
• Magnetic resonance imaging (MRI) revealed symmetric white matter lesions, a finding not previously documented in this context.
• The prompt response to neomycin suggests its efficacy in managing such cases.

Implications:

• This case underscores the long-term risks associated with ureterosigmoidostomy.
• It emphasizes the importance of recognizing and treating hyperammonemia in patients with this surgical history.
• The novel MRI findings may aid in the diagnosis and understanding of the pathophysiology of hyperammonemic encephalopathy.