A case of hyper-ammonemia indused by an ileovesical fistula after hepatic resection for liver metastasis of rectal cancer

Abstract

The patient was a 68-year-old man who had previous histories of undergoing lower anterior resection of rectum and partial resection of bladder for rectal cancer, hepatic resection for a metastatic tumor, and trans-urethral therapy for a bladder tumor. In February 2009, suddenly he developed disturbance of consciousness and food-contaminated urine. He visited the former hospital, and was diagnosed as having hyper-ammonemia and an ileovesical fistula. He underwent ileo-cecostomy at the proximal ileum of the fistula, but no symptomatic remission was attained. He visited our hospital and underwent, second surgical treatment in October 2009. He had chronic liver failure and diabetes mellitus as preoperative complications. Using the ileo-cecostomy, a pouch of the ileum with the fistula was made for the purpose of the separeation of the fistula from the route of digestion. After the second surgery, the symptoms due to hyper-ammonenia disappeared. We examined the changes in the blood level of ammonia, urea nitrogen, chloride, and potassium after the surgery. The high blood levels of ammonia, urea nitrogen and chloride were significantly deceased after the surgery, but no change in serum potassium level was noted.