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We present a case of a middle-aged woman who presented electively for a total pancreatectomy\u2013duodenectomy with splenectomy, hepatico-jejunostomy, gastro-jejunostomy and developed encephalopathy on postoperative day 10 due to non-cirrhotic hyperammonaemia.<\/jats:p>","DOI":"10.1136\/bcr-2019-233218","type":"journal-article","created":{"date-parts":[[2020,3,31]],"date-time":"2020-03-31T05:35:18Z","timestamp":1585632918000},"page":"e233218","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Non-cirrhotic hyperammonaemia: are we missing the diagnosis?"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7201-2754","authenticated-orcid":false,"given":"Yi Lin","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Surgical Intensive Care, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siying","family":"Pang","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"Ong","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,3,30]]},"reference":[{"key":"2025082702481974000_13.3.e233218.1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2016\/8512721","article-title":"Hyperammonemia: what Urea-lly need to know: case report of severe noncirrhotic hyperammonemic encephalopathy and review of the literature","volume":"2016","author":"Upadhyay","year":"2016","journal-title":"Case Rep Med"},{"key":"2025082702481974000_13.3.e233218.2","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2007.05.070062"},{"key":"2025082702481974000_13.3.e233218.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2008.01.014"},{"key":"2025082702481974000_13.3.e233218.4","doi-asserted-by":"publisher","DOI":"10.1136\/pmj.77.913.717"},{"key":"2025082702481974000_13.3.e233218.5","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A2290"},{"key":"2025082702481974000_13.3.e233218.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2009.02.012"},{"key":"2025082702481974000_13.3.e233218.7","first-page":"551","article-title":"Brain MR imaging in acute hyperammonemic encephalopathy arising from late-onset ornithine transcarbamylase deficiency","volume":"24","author":"Takanashi","year":"2003","journal-title":"AJNR Am J Neuroradiol"},{"key":"2025082702481974000_13.3.e233218.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2004.03.023"},{"key":"2025082702481974000_13.3.e233218.9","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1093\/ajcn\/69.6.1194","article-title":"Hypermetabolism in clinically stable patients with liver cirrhosis","volume":"69","author":"M\u00fcller","year":"1999","journal-title":"Am J Clin Nutr"},{"key":"2025082702481974000_13.3.e233218.10","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1040445"},{"key":"2025082702481974000_13.3.e233218.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2006.01.018"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-233218","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T09:48:27Z","timestamp":1756288107000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-233218"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3]]},"references-count":11,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,3,30]]},"published-print":{"date-parts":[[2020,3]]}},"alternative-id":["10.1136\/bcr-2019-233218"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-233218","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2020,3]]}}}