Ewha Med J.  2015 Mar;38(1):42-45. 10.12771/emj.2015.38.1.42.

Night Blindness Induced by Long-term External Bile Drainage

• Lee SM
• Choi JY
• Kang HJ
• Sung JH
• Park SJ
• Yoo SH
• Park YM

• KMID: 2171328
• DOI: http://doi.org/10.12771/emj.2015.38.1.42

Abstract

Vitamin A deficiency can occur as a result of malnutrition, malabsorption, or poor vitamin metabolism due to liver disease and night blindness might develop as the first symptom. Although there have been foreign reports about night blindness due to vitamin A deficiency which was derived from liver cirrhosis, primary biliary cirrhosis, intestinal bypass surgery or bariatric operation, it is hard to find reports about night blindness after percutaneous transhepatic biliary drainage for external bile drainage. We report a case of night blindness derived from fat-soluble vitamin A deficiency developed after long-term (18 months) external bile drainage for benign biliary stricture occurred after left hepatic lobectomy and hepaticojejunostomy due to the Klatskin tumor (IIIb). Her night blindness and low serum retinol level (0.02 mg/L) was dramatically improved after vitamin A supplementation. We recommend lipid-soluble vitamin supplementation on the case of long-term external bile drainage.

Keyword

Vitamin A deficiency; Night blindness; Percutaneous transhepatic biliary drainage

MeSH Terms

Bile*
Constriction, Pathologic
Drainage*
Jejunoileal Bypass
Klatskin's Tumor
Liver Cirrhosis
Liver Cirrhosis, Biliary
Liver Diseases
Malnutrition
Metabolism
Night Blindness*
Vitamin A
Vitamin A Deficiency
Vitamins
Vitamin A
Vitamins

Figure

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  Fig. 1 Magnetic resonance cholangiopancreatography 3 years after the operation. Severe stenosis is noticed at hepaticojejunostomy site (arrow).

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  Fig. 2 Percutaneous transhepatic biliary drainage is placed at the bile duct of posterior inferior segment (B6).

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  Fig. 3 Magnetic resonance cholangiopancreatograph (MRCP) 4 years after the operation. There is no change compared with the previous MRCP.

Reference

1. Braunstein A, Trief D, Wang NK, Chang S, Tsang SH. Vitamin A deficiency in New York City. Lancet. 2010; 376:267.

2. Chae T, Foroozan R. Vitamin A deficiency in patients with a remote history of intestinal surgery. Br J Ophthalmol. 2006; 90:955–956.

3. Slater GH, Ren CJ, Siegel N, Williams T, Barr D, Wolfe B, et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg. 2004; 8:48–55.

4. Goodman DS. Vitamin A and retinoids in health and disease. N Engl J Med. 1984; 310:1023–1031.

5. Mahmood K, Samo AH, Jairamani KL, Ali G, Talib A, Qazmi W. Serum retinol binding protein as an indicator of vitamin A status in cirrhotic patients with night blindness. Saudi J Gastroenterol. 2008; 14:7–11.

6. Waqar S, Kersey T, Byles D. Night blindness in primary biliary cirrhosis. CMAJ. 2010; 182:1212.

7. Phillips JR, Angulo P, Petterson T, Lindor KD. Fat-soluble vitamin levels in patients with primary biliary cirrhosis. Am J Gastroenterol. 2001; 96:2745–2750.

8. Walt RP, Kemp CM, Lyness L, Bird AC, Sherlock S. Vitamin A treatment for night blindness in primary biliary cirrhosis. Br Med J (Clin Res Ed). 1984; 288:1030–1031.

9. Yoon DH, Lee SW, Choi U. Opthalmology. 7th ed. Seoul: Ilchokak;2006.

10. Smith J, Steinemann TL. Vitamin A deficiency and the eye. Int Ophthalmol Clin. 2000; 40:83–91.