title: Gradual improvement of hyperammonemic hepatic encephalopathy after the extirpation of a large uterine leiomyoma in a woman with constipation and liver cirrhosis resulting from autoimmune hepatitis.
abstract: There have been few reports regarding the improvement of hyperammonemic hepatic encephalopathy after the extirpation of a large uterine leiomyoma. We present a case of a 53-year-old postmenopausal woman who experienced a clouding of consciousness. She had been suffering from mild hepatitis and a large uterine leiomyoma. On admission, she had experienced constipation for seven days and exhibited a high serum ammonia level (251 μg/dL). She was diagnosed with liver cirrhosis as a result of autoimmune hepatitis, combined with Sjögren's syndrome. A total hysterectomy was performed 29 days after admission. Severe diarrhea lasted for three days after surgery. By the sixth postoperative day, the patient's consciousness level had normalized and her serum ammonia level had fallen to 47 μg/dL. Although the true mechanism of hyperammonemia in this case is unclear, we speculate that organic constipation following chronic obstruction of the colon might have played a role in the development of the condition.
authors.affiliation: Department of Internal Medicine, Kamiamakusa-Shiritsu Kamiamakusa Sogo Byoin, Kamiamakusa-shi, Japan.
authors.forename: Koutaro
authors.initials: K
authors.lastname: Kunitomo
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Shimotsuke-shi, Japan.
authors.forename: Akihide
authors.initials: A
authors.lastname: Ohkuchi
authors.affiliation: Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Omiya, Japan.
authors.forename: Satohiro
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: Department of Internal Medicine, Kamiamakusa-Shiritsu Kamiamakusa Sogo Byoin, Kamiamakusa-shi, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Wada
authors.affiliation: Department of Obstetrics and Gynecology, Kamiamakusa-Shiritsu Kamiamakusa Sogo Byoin, Kamiamakusa-shi, Japan.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Himeno
authors.affiliation: Department of Internal Medicine, Kamiamakusa-Shiritsu Kamiamakusa Sogo Byoin, Kamiamakusa-shi, Japan.
authors.forename: Tatsuyoshi
authors.initials: T
authors.lastname: Sakamoto
mesh_terms: D000641:Ammonia / Q000097:blood*; D003248:Constipation / Q000209:etiology; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood* / Q000209:etiology; D019693:Hepatitis, Autoimmune / Q000150:complications; D006801:Humans; D007889:Leiomyoma / Q000601:surgery*; D008103:Liver Cirrhosis / Q000209:etiology; D008875:Middle Aged; D017698:Postmenopause; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000601:surgery*
chemical_list: D000641:Ammonia
keywords: constipation; hyperammonemia; liver cirrhosis; uterine leiomyoma