A 75-year-old female patient presented to the accident and emergency department following a collapse. She was treated for a saddle pulmonary embolism and underlying urinary tract infection. However, 48 hours later she was found to have reduced consciousness with no apparent cause (Glasgow Coma Scale of 8 out of 15). Subsequent blood results revealed a highammonia level. After reflection into her medical history, it was found that she had bladder exstrophy, which was managed with urinary diversion surgery as an infant, and her presentation was a rare complication of this operation.
- urological surgery
- congenital disorders
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Contributors YJP, SD, DS and KA conceived the idea of submitting this case to the BMJ. YJP consented patient. YJP and SD collected patient’s admissions information. YJP wrote the manuscript with support from DS and SD. YJP obtained figures for the manuscript. SD and DS assisted in editing of the manuscript and references. KA was the supervisor of this project and contributed in the final editing of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Obtained.
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