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

Maruyama M, Miyasaka Y, Takano A, Inoue M, Furuya K, Sugai H, Hada M, Nakagomi H - Surg Case Rep (2015)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yamanashi Prefectural Central Hospital, Fujimi1-1-1, Kofu, Yamanashi, Japan.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

The findings of contrast computed tomography (CT). The huge tumor was occupying in minor pelvic space and invading to the bladder and small intestine. White arrow indicates the urinary bladder with tumor invasion and air-fluid level. aBlack arrows indicated liver metastases with the size of 1.1 cm (b) and 1.2 cm (c)
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Fig2: The findings of contrast computed tomography (CT). The huge tumor was occupying in minor pelvic space and invading to the bladder and small intestine. White arrow indicates the urinary bladder with tumor invasion and air-fluid level. aBlack arrows indicated liver metastases with the size of 1.1 cm (b) and 1.2 cm (c)

Mentions: Contrast computed tomography (CT) indicated the huge tumor occupying minor pelvic space which was suspected to invade the ureter and urinary bladder (Fig. 2a). Two liver metastases with the sizes of 1.1 and 1.2 cm were also observed (Fig. 2b and c).Fig. 2


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

Maruyama M, Miyasaka Y, Takano A, Inoue M, Furuya K, Sugai H, Hada M, Nakagomi H - Surg Case Rep (2015)

The findings of contrast computed tomography (CT). The huge tumor was occupying in minor pelvic space and invading to the bladder and small intestine. White arrow indicates the urinary bladder with tumor invasion and air-fluid level. aBlack arrows indicated liver metastases with the size of 1.1 cm (b) and 1.2 cm (c)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4582075&req=5

Fig2: The findings of contrast computed tomography (CT). The huge tumor was occupying in minor pelvic space and invading to the bladder and small intestine. White arrow indicates the urinary bladder with tumor invasion and air-fluid level. aBlack arrows indicated liver metastases with the size of 1.1 cm (b) and 1.2 cm (c)
Mentions: Contrast computed tomography (CT) indicated the huge tumor occupying minor pelvic space which was suspected to invade the ureter and urinary bladder (Fig. 2a). Two liver metastases with the sizes of 1.1 and 1.2 cm were also observed (Fig. 2b and c).Fig. 2

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yamanashi Prefectural Central Hospital, Fujimi1-1-1, Kofu, Yamanashi, Japan.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus