Surgery for gastric cancer in a patient with non-cirrhotic hyperammonemia: a case report

World Journal of Surgical Oncology

Zhen-ning Wang¹  Hui-mian Xu¹  Peng Gao¹  Yong-xi Song¹  Miao Yu¹  Bo Liu¹ 

[1]Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang City 110001, China

关键词: Gastrectomy;    Hyperammonemia;    Gastric cancer;    Spontaneous portacaval shunt;   

Others  :  1130990
DOI  :  10.1186/s12957-015-0500-2

 received in 2014-11-30, accepted in 2015-02-01,  发布年份 2015

【 摘 要 】

We report a case of gastric cancer in a patient with non-cirrhotic hyperammonemia secondary to a spontaneous portacaval shunt. The patient, a 69-year-old male, had more than 40 years of abdominal discomfort. On gastroscopy, 2.0 × 1.5-cm irregular uplift ulcers were seen on the lesser curvature of the stomach, and tissue biopsy revealed poorly differentiated adenocarcinoma. His hyperammonemia was found on celiac angiography to be due to the formation of a spontaneous portacaval shunt. Imaging revealed no evidence of cirrhosis or portal hypertension. The patient ultimately underwent a distal gastrectomy and gastroduodenal anastomosis; the spontaneous portacaval shunt was left untreated. Postoperatively, there were no short-term complications such as anastomotic leakage, stricture, or bleeding, and the patient’s blood ammonia level decreased to within the normal range. Radical gastrectomy without splenectomy or closure of the abnormal shunt was feasible for the treatment of gastric cancer in a patient with non-cirrhotic hyperammonemia.

【 授权许可】

   
2015 Liu et al.; licensee BioMed Central.

【 图 表 】

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【 参考文献 】

• [1]Piazuelo MB, Correa P: Gastric cancer: overview. Colomb Med (Cali) 2013, 44:192-201.
• [2]Miao RL, Wu AW: Towards personalized perioperative treatment for advanced gastric cancer. World J Gastroenterol 2014, 20:11586-94.
• [3]Watanabe A: Portal-systemic encephalopathy in non-cirrhotic patients: classification of clinical types, diagnosis and treatment. J Gastroenterol Hepatol 2000, 15:969-79.
• [4]Szatmari V, Rothuizen J, van den Ingh TS, van Sluijs F, Voorhout G: Ultrasonographic findings in dogs with hyperammonemia: 90 cases (2000–2002). J Am Vet Med Assoc 2004, 224:717-27.
• [5]Ubara Y, Hoshino J, Tagami T, Sawa N, Katori H, Takemoto F, et al.: Hemodialysis-related portal-systemic encephalopathy. Am J Kidney Dis 2004, 44:e38-42.
• [6]Takeda J, Hashimoto K, Tanaka T, Koufuji K, Kakegawa T, Arishima T: Spontaneous portacaval shunts in patients with gastric cancer and hepatic cirrhosis. Kurume Med J 1991, 38:33-7.
• [7]Sekido H, Nakano A, Takahashi T, Matsuo K, Mochizuki Y, Fukushima T, et al.: Hepatic encephalopathy secondary to a large-caliber porto-hepatic venous shunt. A case report. Hepatogastroenterology 1992, 39:316-8.
• [8]Fenves A, Boland CR, Lepe R, Rivera-Torres P, Spechler SJ: Fatal hyperammonemic encephalopathy after gastric bypass surgery. Am J Med 2008, 121:e1-2.
• [9]Patton KM, Peek SF, Valentine BA: Gastric adenocarcinoma in a horse with portal vein metastasis and thrombosis: a novel cause of hepatic encephalopathy. Vet Pathol 2006, 43:565-9.
• [10]Chen JS, Liu HE, Wang CH, Yang TS, Wang HM, Liau CT, et al.: Weekly 24-h infusion of high-dose 5-flurouracil and leucovorin in patients with advanced gastric cancer. Anticancer Drugs 1999, 10:355-9.
• [11]Lin YC, Chen JS, Wang CH, Wang HM, Chang HK, Liaul CT, et al.: Weekly high-dose 5-fluorouracil (5-FU), leucovorin (LV) and bimonthly cisplatin in patients with advanced gastric cancer. Jpn J Clin Oncol 2001, 31:605-9.
• [12]Kim SR, Park CH, Park S, Park JO, Lee J, Lee SY: Genetic polymorphisms associated with 5-Fluorouracil-induced neurotoxicity. Chemotherapy 2010, 56:313-7.
• [13]Tsuji K, Yasui H, Onozawa Y, Boku N, Doyama H, Fukutomi A, et al.: Modified FOLFOX-6 therapy for heavily pretreated advanced gastric cancer refractory to fluorouracil, irinotecan, cisplatin and taxanes: a retrospective study. Jpn J Clin Oncol 2012, 42:686-90.