Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 8, 2015; 7(7): 1007-1011
Published online May 8, 2015. doi: 10.4254/wjh.v7.i7.1007
Hyperammonemia-induced encephalopathy: A rare devastating complication of bariatric surgery
Michelle L Kromas, Omar Y Mousa, Savio John
Michelle L Kromas, Department of Anesthesiology, SUNY Upstate Medical University, Syracuse, NY 13210, United States
Omar Y Mousa, Savio John, Department of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, United States
Author contributions: Kromas ML and Mousa OY participated in patient care and initial evaluation, diagnosis, and follow-up of patient as described in report; Kromas ML, Mousa OY and John S analyzed the laboratory and imaging findings and conducted review of previous publications and wrote the paper.
Ethics approval: The case report was deemed to meet criteria for exemption from review by SUNY Upstate Medical University Institutional Review Board.
Informed consent: The patient provided informed verbal consent for inclusion in case report at time of discharge from hospital.
Conflict-of-interest: The authors including Michelle L Kromas, Omar Y Mousa, Savio John have no conflicts of interest to disclose including but not limited to receipt of research funding, fees for service as speakers, or owning shares or stocks in any organizations.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Omar Y Mousa, MD, Department of Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, United States. omar.mousa@hotmail.com
Telephone: +1-315-4644480 Fax: +1-315-4644484
Received: December 16, 2014
Peer-review started: December 17, 2014
First decision: January 8, 2015
Revised: January 26, 2015
Accepted: March 16, 2015
Article in press: March 18, 2015
Published online: May 8, 2015
Processing time: 147 Days and 22.7 Hours
Core Tip

Core tip: Encephalopathy secondary to hyperammonemia in the absence of hepatic dysfunction presents a diagnostic dilemma to many clinicians. As such, early and accurate diagnosis can be easily missed, leading to increased morbidity and mortality. We describe a case of adult onset urea cycle disorder presenting with encephalopathy after gastric bypass surgery. Although this challenging diagnosis is rare, treatment is inexpensive and readily available. Thus early recognition and intervention can prevent the rapid decline that may occur if the diagnosis is unrecognized.