[Hyperammonaemic encephalopathy, possible complication after urinary diversion in radical cystectomy. Review of the literature with regard to a clinical case].
BACKGROUND
Radical cystectomy is an intervention with an important morbidity. Urinary diversion is a possible cause of metabolic complications like hyperammonaemic encephalopathy.


METHODS
We present the case of a patient treated with a radical cystectomy and modified ureterosigmoidostomy after diagnosis of bladder cancer. After surgery the patient presented in 4 ocasions recurrent episodic confusion. Laboratory and image tests were normal. Levels of seric ammonium was increased. After supportive treatment and hemodyalisis symptoms disappeared. Later patient was reoperated and a reconstruction to ileal conduit was made.


CONCLUSIONS
Continent urinary diversions are advised due to important negative impact on quality of life produced by ileal conduit. However these diversions have several complications, like encephalopathy secondary to non-hepatic hyperammonaemia. Increased absortion of ammonium by intestinal tissue of the new-ladder induces encephalopathy. Early diagnosis of this complication is essencial in order to administer an effective treatment.
Pérez-Fidalgo
J A
JA
Servicios de Oncologia Médica, Hospital Clinico Universitario, Valencia. japfidalgo@msn.com
Chirivella González
I
I
Günthner
S
S
Cervera Miguel
J I
JI
March Villalba
J A
JA
Cervantes Ruipérez
A
A
D000368:Aged; D001927:Brain Diseases / Q000209:etiology*; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D022124:Hyperammonemia / Q000209:etiology*; D014547:Urinary Diversion / Q000009:adverse effects*