Ann Hepatobiliary Pancreat Surg.  2019 Aug;23(3):295-299. 10.14701/ahbps.2019.23.3.295.

A case of Wernicke's encephalopathy following complicated laparoscopic pylorus-preserving pancreaticoduodenectomy

• Kim JS
• Rho SY
• Hwang HK
• Lee WJ
• Kang CM

• KMID: 2456031
• DOI: http://doi.org/10.14701/ahbps.2019.23.3.295

Abstract

Laparoscopic pylorus-preserving pancreaticoduodenectomy (PPPD)/pancreaticoduodenectomy (PD) is cautiously regarded as a safe and effective approach in well-selected patients with periampullary cancer. However, postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), postoperative bleeding, and sepsis and detrimental complications that can follow PPPD/PD. These complications can result in poor oral intake for a significant period of nothing per oral (NPO) or deterioration of long-term function. A 65-year-old man underwent laparoscopic PPPD for ampulla of vater (AoV) cancer. After surgery, He experienced POPF, DGE, Postoperative bleeding and these complications result in poor oral intake for one month. Approximately 50 days after surgery, an abrupt confused state was noted. He had horizontal nystagmus and ataxia. Abnormal Brain magnetic resonance imaging tomography findings detected in the bilateral medial thalami, dorsal midbrain, and medulla. The association of confusion, ataxia, and horizontal nystagmus along with poor oral intake and the MRI findings suggested acute Wernicke's encephalopathy. After thiamine therapy, He recovered completely. Wernicke's encephalopathy is very rare, but it can progress coma and even death. Therefore, Wernicke's encephalopathy needs to be considered in patients with complicated PPPD/PD associated with malnutrition.

Keyword

Wernicke's encephalopathy; PPPD; PD; Thiamine deficiency

MeSH Terms

Aged
Ampulla of Vater
Ataxia
Brain
Coma
Gastric Emptying
Hemorrhage
Humans
Magnetic Resonance Imaging
Malnutrition
Mesencephalon
Nystagmus, Pathologic
Pancreatic Fistula
Pancreaticoduodenectomy*
Sepsis
Thiamine
Thiamine Deficiency
Wernicke Encephalopathy*
Thiamine

Figure

• 

  Fig. 1 Fluid-attenuated inversion recovery-weighted axial (A–C) and sagittal (D) magnetic resonance imaging scans showed abnormal, symmetrical, hyperintense signal (arrows) in the bilateral medial thalami, dorsal midbrain, and medulla.

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