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

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-04-10 DOI:10.1016/j.clnesp.2025.03.165

Maurine Allard , Mylène Guiho , Audrey Le Ruyet-Le Henaff , Caroline Moreau , Ronan Thibault

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Abstract

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.

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肥胖患者经ω -环胃旁路治疗后出现高氨血症脑病1例报告及讨论

背景：高氨血症脑病是一种罕见但潜在致命的疾病，可在肥胖手术后发生。病例报告：一名43岁的白人女性，有omega-环胃旁路手术史，伴有水肿、呼吸困难和严重营养不良。入院后3次昏迷，生化检查显示高氨血症、低白蛋白血症和高谷氨酰胺血症。病因调查不支持尿素循环紊乱，而是一种营养灾难，严重营养不良继发于ω -环胃旁路术。讨论有肥胖手术史的患者，应注意脑病症状导致的高氨血症和营养不良。结论本报告证明了在有肥胖手术史的患者出现神经系统症状时进行氨血症检测的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.