Hyperammonemia after liver surgery: A case report of an unanticipated postoperative challenge.

Hepatic encephalopathy after liver surgery is an uncommon but serious complication. In this context, we describe an unusual case of a patient with a history of uretero-sigmoidostomy who developed severe hepatic encephalopathy following hepatectomy for liver metastases of colorectal cancer. Mechanical ventilation, ammonia-lowering drugs and continuous veno-venous hemofiltration were required in order to reverse encephalopathy. It is hypothesized that ammonia reabsorption via the uretero-sigmoidostomy played a pivotal role in the clinical course of this patient. This report highlights the need for awareness for reabsorption of ammonia in case of a ureterosigmoidostomy in order to avoid unnecessary complications.