Non-cirrhotic Hyperammonemia causing altered sensorium in a patient who underwent Urinary diversion 43 years ago.

Ureterosigmoidostomy, a urinary diversion procedure performed for treatment of congenital urologic defects or bladder cancer, can rarely presents with hyperammonemia even in the absence of coexistent liver disease. Here, we report the case of a 47-year-old man who developed hyperammonic encephalopathy 43 years after ureterosigmoidostomy. Therefore, hyperammonemic encephalopathy after ureterosigmoidostomy is an iatrogenic, but treatable problem which must be considered in the differential diagnosis of altered consciousness in the critical care settings