Postbariatric Surgery Hyperammonemia: A Rare Cause of Encephalopathy.
gastric bypass surgery, hyperammonemic encephalopathy, urea cycle disorder, complications, obesity
Analytical, Diagnostic and Therapeutic Techniques and Equipment | Pathological Conditions, Signs and Symptoms | Surgical Procedures, Operative | Therapeutics
Hyperammonemic encephalopathy is an under-recognized and potentially fatal complication of Roux-en-Y gastric bypass surgery. We present a case of a 42-year-old woman with no known history of liver disease who experienced worsening encephalopathy 1 year after bariatric surgery. She presented with elevated ammonia and severe encephalopathy requiring intubation. A complete workup led to the diagnosis of a urea cycle disorder. The patient was managed with lactulose, ammonia scavenging agents, and nutritional supplementation with a favorable outcome. We report this case to increase awareness of this condition and urge providers to maintain a high clinical suspicion in the appropriate setting.
Publisher or Conference
ACG Case Reports Journal
Castineira J, Goltser Y, Vila M, et al. Postbariatric Surgery Hyperammonemia: A Rare Cause of Encephalopathy. ACG Case Rep J. 2019;6(7):e00119. Published 2019 Jul 22. doi:10.14309/crj.0000000000000119