Hyperammonemic encephalopathy related to ureterosigmoidostomy

Area of Science:

• Nephrology
• Neurology
• Gastroenterology

Background:

• Urinary diversion to the colon is a surgical procedure that reroutes urine flow into the large intestine.
• This procedure can lead to complications such as elevated blood ammonia levels.

Observation:

• A patient presented with metabolic encephalopathy, a condition affecting brain function.
• The patient had undergone urinary diversion to the colon and exhibited elevated blood ammonia levels.
• Brain imaging revealed diffuse swelling and superficial contrast enhancement.

Findings:

• The patient's metabolic encephalopathy was linked to elevated blood ammonia levels, a condition resembling hepatic encephalopathy.
• Crucially, this encephalopathy occurred without apparent liver disease.
• Computed tomography scans showed diffuse brain swelling and superficial contrast enhancement.

Implications:

• This condition underscores the importance of considering urinary diversion as a potential cause of unexplained metabolic encephalopathy.
• Prompt diagnosis and reduction of blood ammonia levels are critical for effective treatment.
• High clinical suspicion is essential for identifying this complication in at-risk patients.