A Case of Hyper-Ammonemia Indused by an Ileovesical Fistula After Hepatic Resection for Liver Metastasis of Rectal Cancer

Orihata, Michihiro; Tukada, Kenji; Kunii, Y; Haraguchi, Yoshiaki; Kobayashi, Shigeru; Kamano, Toshiki

doi:10.3919/jjsa.72.1810

Cited by 2 publications

(4 citation statements)

References 2 publications

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“…Maruyama et al reported nonhepatic hyperammonemic encephalopathy in a patient with vesicorectal and ileal fistulae due to rectal cancer 10 . Orihata et al reported hyperammonemic encephalopathy in a patient who suffered from rectal cancer resulting in vesicoileal fistula and liver dysfunction due to multiple liver metastasis 11 . To the best of our knowledge, this case report is the first case of hyperammonemic encephalopathy associated with postradiotherapy vesicointestinal fistula.…”

Section: Discussionmentioning

confidence: 71%

“…UTI caused by urease‐producing bacteria such as Proteus and Klebsiella increases ammonia in urine 3–5 . Absorption via the bladder wall (especially in obstructive uropathy) 6–9 or the intestinal wall (in cases with vesicointestinal fistula 10,11 or urinary diversion) 12 can result in hyperammonemic encephalopathy. We report the first case of hyperammonemic encephalopathy associated with vesicosigmoidal and vesicocecal fistulae as a long‐term complication of radiotherapy for cervical cancer.…”

Section: Introductionmentioning

confidence: 99%

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Hyperammonemic encephalopathy associated with post‐radiotherapy vesicointestinal fistula following cervical cancer

Kato

Okumura²,

Suzuki

et al. 2021

J of Obstet and Gynaecol

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The majority of hyperammonemic encephalopathy is due to liver cirrhosis. However, urinary tract infection caused by urease‐producing bacteria increases ammonia in urine and can lead to hyperammonemic encephalopathy, especially in cases with obstructive uropathy and vesicointestinal fistula. This is the first case report of hyperammonemic encephalopathy in a cervical cancer patient associated with postradiotherapy vesicointestinal fistula. A 52‐year‐old woman developed diarrhea due to vesicosigmoidal fistula 14 years after radical hysterectomy and radiotherapy to treat cervical cancer. She refused urinary and/or fecal diversion. Twelve months after the diagnosis of fistula, she was admitted due to somnolence. Blood examination showed hyperammonemia without liver dysfunction. Urine culture showed Proteus rettgeri and Klebsiella pneumoniae. She recovered after intravenous antibiotics. Eight months after recovery, she was readmitted due to somnolence reoccurring with failed intravenous, but successful oral antibiotic treatment. She finally agreed to undergo percutaneous nephrostomy and hyperammonemia never recurred during 7 years of follow‐up.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Hyperammonemic encephalopathy associated with post‐radiotherapy vesicointestinal fistula following cervical cancer

Kato

Okumura²,

Suzuki

et al. 2021

J of Obstet and Gynaecol

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“…Some cases have been reported in patients who underwent a urinary diversion due to bladder or prostate cancer [ 10 ]. To the best of our knowledge, only one case with rectal cancer was previously reported in the Japanese literature, in which the patient suffered from a rectovesical fistula and liver dysfunction due to multiple liver metastases [ 8 ].…”

Section: Case Presentationmentioning

confidence: 99%

“…Hyperammonemia due to rectovesical fistula caused by rectal cancer is extremely rare. We could find only one case report in the Japanese literature [ 8 ]. Therefore, the pathologic physiology may be presumed according to the reports of ureterosigomoidostomy due to bladder or prostate cancer [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

A case of advanced rectal cancer with rectovesical and ileal fistulae that developed hyperammonemic encephalopathy

et al. 2015

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Hyperammonemic encephalopathy is rarely caused by a urinary diversion. We herein experienced a case of rectal carcinoma with rectovesical and ileal fistulae that developed hyperammonemic encephalopathy. A 72-year-old man suffered from a fever, diarrhea, pneumaturia, and fecaluria beginning in April 2013 and was referred to our hospital in May 2013. He developed a loss of consciousness and whole body cramping on the first hospital day. The laboratory data indicated an inflammatory reaction and hyperammonemia with a highly elevated serum ammonia (NH3) level of 703 μg/dl.The patient was diagnosed to have rectal carcinoma with rectovesical and ileal fistulae according to computed tomography (CT) and a water-soluble contrast enema.We administered a solution of branched chain amino acids (BCAA) and antibiotics. Furthermore, we repeatedly irrigated bladder through the urethral catheter. The patient’s symptoms recovered, and the serum ammonia levels on the second and third hospital day were decreased to 210 and 135 μg/dl, respectively. However, the symptoms of infection and confusion were suspected to repeat; we elected to perform surgical treatment. An ileal disconnection with ileocecal bypass and sigmoidostomy were effective for preventing hyperammonemic encephalopathy.

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A Case of Hyper-Ammonemia Indused by an Ileovesical Fistula After Hepatic Resection for Liver Metastasis of Rectal Cancer

Cited by 2 publications

References 2 publications

Hyperammonemic encephalopathy associated with post‐radiotherapy vesicointestinal fistula following cervical cancer

Hyperammonemic encephalopathy associated with post‐radiotherapy vesicointestinal fistula following cervical cancer

A case of advanced rectal cancer with rectovesical and ileal fistulae that developed hyperammonemic encephalopathy

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