Hyperammonemic encephalopathy after omega-loop gastric bypass for obesity: a case report and discussion.

BACKGROUND Hyperammonemic encephalopathy is a rare but potentially fatal condition, that can occur after obesity surgery. CASE REPORT A 43-year-old Caucasian woman, with history of omega-loop gastric bypass, with hydrops, dyspnoea and severe malnutrition was referred for evaluation. After admission to medical department, she experienced three episodes of coma, and biochemical investigations showed hyperammonemia, hypoalbuminemia and hyperglutaminemia. Etiological investigations were not in favour of a urea cycle disorder, but rather a nutritional catastrophe with severe malnutrition secondary to the omega-loop gastric bypass. DISCUSSION In patients with history of obesity surgery, encephalopathy symptoms should lead to look after hyperammonemia and malnutrition. CONCLUSION This report demonstrates the importance of ammonemia testing in case of neurological symptoms in patients with a history of obesity surgery.

• Publication year

  2025

• Venue

  Clinical Nutrition ESPEN

• Publication date

  2025-04-01

• Fields of study

  Medicine

• Identifiers
  DOI 10.1016/j.clnesp.2025.03.165PMID 40216359
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass at 5 years (YOMEGA): a prospective, open-label, non-inferiority, randomised extension study.

  2024cited by this paper
• Nonhepatic hyperammonemic encephalopathy following bariatric surgery: A systematic review.

  2023cited by this paper
• Hyperammonemic Encephalopathy in Multiple Myeloma: A Case Report

  2023cited by this paper
• Valproate-Associated Hyperammonemic Encephalopathy

  2023cited by this paper
• Nonhepatic hyperammonemic encephalopathy complications following bariatric surgery: a case report and review of the literature

  2021cited by this paper
• Sunitinib-associated hyperammonemic encephalopathy.

  2020cited by this paper
• Hyperammonemic Encephalopathy: A Complication of Gastric Bypass Surgery

  2020cited by this paper
• The Efficacy of Lactulose for the Treatment of Hyperammonemic Encephalopathy Due to Severe Heart Failure

  2020cited by this paper
• Amino and organic acid analysis: Essential tools in the diagnosis of inborn errors of metabolism.

  2019cited by this paper
• Nonfatal Hyperammonemic Encephalopathy as a Late Complication of Roux-en-Y Gastric Bypass

  2019cited by this paper
• Bariatric Surgery Causing Hyperammonemia

  2019cited by this paper
• Challenges in diagnosing and managing adult patients with urea cycle disorders

  2019cited by this paper
• Acute hyperammonemic encephalopathy after fluoropyrimidine-based chemotherapy

  2017cited by this paper
• Roux-en-Y gastric bypass for the treatment of severe complications after omega-loop gastric bypass.

  2017cited by this paper
• Late Presentation of Fatal Hyperammonemic Encephalopathy After Roux-En-Y Gastric Bypass

  2017cited by this paper
• ESPEN guidelines on definitions and terminology of clinical nutrition.

  2017cited by this paper
• Recognition and management of hyperinsulinemic hypoglycemia after bariatric surgery.

  2016cited by this paper
• Hyperammonemia: What Urea-lly Need to Know: Case Report of Severe Noncirrhotic Hyperammonemic Encephalopathy and Review of the Literature

  2016cited by this paper
• Hyperammonemia-induced encephalopathy: A rare devastating complication of bariatric surgery.

  2015cited by this paper
• Hyperammonemic syndrome after Roux‐en‐Y gastric bypass

  2015cited by this paper
• Multiple myeloma-induced hyperammonemic encephalopathy: an entity associated with high in-patient mortality.

  2013cited by this paper
• Suggested guidelines for the diagnosis and management of urea cycle disorders

  2012cited by this paper
• Acute Hyperammonemic Encephalopathy in Adults: Imaging Findings

  2011cited by this paper
• Clinical practice

  2010cited by this paper
• Neurologic complications of gastric bypass surgery for morbid obesity

  2007cited by this paper
• Clinical, biochemical, and molecular spectrum of hyperargininemia due to arginase I deficiency

  2006cited by this paper
• Inherited and Acquired Syndromes of Hyperammonemia and Encephalopathy in Children

  1994cited by this paper
• Protein synthesis and breakdown and amino acid catabolism in protein-calorie malnutrition

  1972cited by this paper

• Non-hepatic Hyperammonemia Encephalopathy: A Late Complication of Roux-en-Y-Gastric Bypass

  2025cites this paper