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

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...
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Autor*in:	Maruyama, Masahiro [verfasserIn] Miyasaka, Yoshiaki Takano, Atsushi Inoue, Masayuki Furuya, Kazushige Sugai, Hidemitsu Hada, Masao Nakagomi, Hiroshi

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2015

Schlagwörter:	Hyperammonemic encephalopathy Rectal cancer Rectovesical and ileal fistulae

Anmerkung:	© Maruyama et al. 2015

Übergeordnetes Werk:	Enthalten in: Surgical case reports - Berlin : SpringerOpen, 2015, 1(2015), 1 vom: 24. Sept.
Übergeordnetes Werk:	volume:1 ; year:2015 ; number:1 ; day:24 ; month:09

Links:	Volltext

DOI / URN:	10.1186/s40792-015-0088-3

Katalog-ID:	SPR037751360

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520			\|a 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.
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allfields	10.1186/s40792-015-0088-3 doi (DE-627)SPR037751360 (SPR)s40792-015-0088-3-e DE-627 ger DE-627 rakwb eng Maruyama, Masahiro verfasserin aut A case of advanced rectal cancer with rectovesical and ileal fistulae that developed hyperammonemic encephalopathy 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Maruyama et al. 2015 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. Hyperammonemic encephalopathy (dpeaa)DE-He213 Rectal cancer (dpeaa)DE-He213 Rectovesical and ileal fistulae (dpeaa)DE-He213 Miyasaka, Yoshiaki aut Takano, Atsushi aut Inoue, Masayuki aut Furuya, Kazushige aut Sugai, Hidemitsu aut Hada, Masao aut Nakagomi, Hiroshi aut Enthalten in Surgical case reports Berlin : SpringerOpen, 2015 1(2015), 1 vom: 24. Sept. (DE-627)818040475 (DE-600)2809613-7 2198-7793 nnns volume:1 year:2015 number:1 day:24 month:09 https://dx.doi.org/10.1186/s40792-015-0088-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 1 2015 1 24 09
spelling	10.1186/s40792-015-0088-3 doi (DE-627)SPR037751360 (SPR)s40792-015-0088-3-e DE-627 ger DE-627 rakwb eng Maruyama, Masahiro verfasserin aut A case of advanced rectal cancer with rectovesical and ileal fistulae that developed hyperammonemic encephalopathy 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Maruyama et al. 2015 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. Hyperammonemic encephalopathy (dpeaa)DE-He213 Rectal cancer (dpeaa)DE-He213 Rectovesical and ileal fistulae (dpeaa)DE-He213 Miyasaka, Yoshiaki aut Takano, Atsushi aut Inoue, Masayuki aut Furuya, Kazushige aut Sugai, Hidemitsu aut Hada, Masao aut Nakagomi, Hiroshi aut Enthalten in Surgical case reports Berlin : SpringerOpen, 2015 1(2015), 1 vom: 24. Sept. (DE-627)818040475 (DE-600)2809613-7 2198-7793 nnns volume:1 year:2015 number:1 day:24 month:09 https://dx.doi.org/10.1186/s40792-015-0088-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 1 2015 1 24 09
allfields_unstemmed	10.1186/s40792-015-0088-3 doi (DE-627)SPR037751360 (SPR)s40792-015-0088-3-e DE-627 ger DE-627 rakwb eng Maruyama, Masahiro verfasserin aut A case of advanced rectal cancer with rectovesical and ileal fistulae that developed hyperammonemic encephalopathy 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Maruyama et al. 2015 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. Hyperammonemic encephalopathy (dpeaa)DE-He213 Rectal cancer (dpeaa)DE-He213 Rectovesical and ileal fistulae (dpeaa)DE-He213 Miyasaka, Yoshiaki aut Takano, Atsushi aut Inoue, Masayuki aut Furuya, Kazushige aut Sugai, Hidemitsu aut Hada, Masao aut Nakagomi, Hiroshi aut Enthalten in Surgical case reports Berlin : SpringerOpen, 2015 1(2015), 1 vom: 24. Sept. (DE-627)818040475 (DE-600)2809613-7 2198-7793 nnns volume:1 year:2015 number:1 day:24 month:09 https://dx.doi.org/10.1186/s40792-015-0088-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 1 2015 1 24 09
allfieldsGer	10.1186/s40792-015-0088-3 doi (DE-627)SPR037751360 (SPR)s40792-015-0088-3-e DE-627 ger DE-627 rakwb eng Maruyama, Masahiro verfasserin aut A case of advanced rectal cancer with rectovesical and ileal fistulae that developed hyperammonemic encephalopathy 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Maruyama et al. 2015 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. Hyperammonemic encephalopathy (dpeaa)DE-He213 Rectal cancer (dpeaa)DE-He213 Rectovesical and ileal fistulae (dpeaa)DE-He213 Miyasaka, Yoshiaki aut Takano, Atsushi aut Inoue, Masayuki aut Furuya, Kazushige aut Sugai, Hidemitsu aut Hada, Masao aut Nakagomi, Hiroshi aut Enthalten in Surgical case reports Berlin : SpringerOpen, 2015 1(2015), 1 vom: 24. Sept. (DE-627)818040475 (DE-600)2809613-7 2198-7793 nnns volume:1 year:2015 number:1 day:24 month:09 https://dx.doi.org/10.1186/s40792-015-0088-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 1 2015 1 24 09
allfieldsSound	10.1186/s40792-015-0088-3 doi (DE-627)SPR037751360 (SPR)s40792-015-0088-3-e DE-627 ger DE-627 rakwb eng Maruyama, Masahiro verfasserin aut A case of advanced rectal cancer with rectovesical and ileal fistulae that developed hyperammonemic encephalopathy 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Maruyama et al. 2015 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. Hyperammonemic encephalopathy (dpeaa)DE-He213 Rectal cancer (dpeaa)DE-He213 Rectovesical and ileal fistulae (dpeaa)DE-He213 Miyasaka, Yoshiaki aut Takano, Atsushi aut Inoue, Masayuki aut Furuya, Kazushige aut Sugai, Hidemitsu aut Hada, Masao aut Nakagomi, Hiroshi aut Enthalten in Surgical case reports Berlin : SpringerOpen, 2015 1(2015), 1 vom: 24. Sept. (DE-627)818040475 (DE-600)2809613-7 2198-7793 nnns volume:1 year:2015 number:1 day:24 month:09 https://dx.doi.org/10.1186/s40792-015-0088-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 1 2015 1 24 09
language	English
source	Enthalten in Surgical case reports 1(2015), 1 vom: 24. Sept. volume:1 year:2015 number:1 day:24 month:09
sourceStr	Enthalten in Surgical case reports 1(2015), 1 vom: 24. Sept. volume:1 year:2015 number:1 day:24 month:09
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	Hyperammonemic encephalopathy Rectal cancer Rectovesical and ileal fistulae
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container_title	Surgical case reports
authorswithroles_txt_mv	Maruyama, Masahiro @@aut@@ Miyasaka, Yoshiaki @@aut@@ Takano, Atsushi @@aut@@ Inoue, Masayuki @@aut@@ Furuya, Kazushige @@aut@@ Sugai, Hidemitsu @@aut@@ Hada, Masao @@aut@@ Nakagomi, Hiroshi @@aut@@
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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. 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author	Maruyama, Masahiro
spellingShingle	Maruyama, Masahiro misc Hyperammonemic encephalopathy misc Rectal cancer misc Rectovesical and ileal fistulae A case of advanced rectal cancer with rectovesical and ileal fistulae that developed hyperammonemic encephalopathy
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topic_title	A case of advanced rectal cancer with rectovesical and ileal fistulae that developed hyperammonemic encephalopathy Hyperammonemic encephalopathy (dpeaa)DE-He213 Rectal cancer (dpeaa)DE-He213 Rectovesical and ileal fistulae (dpeaa)DE-He213
topic	misc Hyperammonemic encephalopathy misc Rectal cancer misc Rectovesical and ileal fistulae
topic_unstemmed	misc Hyperammonemic encephalopathy misc Rectal cancer misc Rectovesical and ileal fistulae
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title	A case of advanced rectal cancer with rectovesical and ileal fistulae that developed hyperammonemic encephalopathy
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title_full	A case of advanced rectal cancer with rectovesical and ileal fistulae that developed hyperammonemic encephalopathy
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author_browse	Maruyama, Masahiro Miyasaka, Yoshiaki Takano, Atsushi Inoue, Masayuki Furuya, Kazushige Sugai, Hidemitsu Hada, Masao Nakagomi, Hiroshi
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title_sort	case of advanced rectal cancer with rectovesical and ileal fistulae that developed hyperammonemic encephalopathy
title_auth	A case of advanced rectal cancer with rectovesical and ileal fistulae that developed hyperammonemic encephalopathy
abstract	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. © Maruyama et al. 2015
abstractGer	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. © Maruyama et al. 2015
abstract_unstemmed	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. © Maruyama et al. 2015
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title_short	A case of advanced rectal cancer with rectovesical and ileal fistulae that developed hyperammonemic encephalopathy
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author2	Miyasaka, Yoshiaki Takano, Atsushi Inoue, Masayuki Furuya, Kazushige Sugai, Hidemitsu Hada, Masao Nakagomi, Hiroshi
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up_date	2024-07-03T14:10:34.126Z
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A case of advanced rectal cancer with rectovesical and ileal fistulae that developed hyperammonemic encephalopathy

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