Wernicke’s encephalopathy after sleeve gastrectomy: Literature review

Highlights

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  Wernicke encephalopathy after sleeve gastrectomy is an uncommon complication.

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  Wernicke encephalopathy reaches 20% mortality rate when it is undertreated.

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  Treatment with thiamine vitamin must be started with a presumptive diagnosis.

Abstract

Objective

To describe a case of Wernicke’s encephalopathy after laparoscopic sleeve gastrectomy.

Setting

Emergency Department and gastrointestinal surgery department.

Case report

A 20-year-old man class III obesity (BMI 50.17 kg/m ²) underwent laparoscopic sleeve gastrectomy with uneventful recovery. Five weeks after surgery he was admitted in the Emergency Department because of persistent vomiting and dysphagia to solids. Esophagogastroduodenal transit and upper gastrointestinal endoscopy were requested but no relevant findings were shown. Laboratory analyses showed vitamin B1 12.2 ng/mL and 48 h following admission the patient experienced generalized weakness, sialorrhea and restrictions of actions such as reading a book. Neurological evaluation found confusion, motor ataxia, diplopy and nystagmus. A brain magnetic resonance was normal. According to low level of vitamin B1 and symptoms found in the patient a presumed diagnosis of Wernicke encephalopathy was made and parenteral thiamine 100 mg/day was started. The patient was discharged asymptomatic with oral intake of vitamin B1 600 mg per day.

Conclusion

Nutritional deficiencies after restrictive procedures are uncommon but easily preventable and can result in life threatening. With the upswing of bariatric surgery, surgeons and emergency physicians should be able to diagnose and treat those complications. Prophylactic thiamine should be administered to patients with predisposing factors.