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A case of Wernicke’s encephalopathy following complicated laparoscopic pylorus-preserving pancreaticoduodenectomy
Ann Hepatobiliary Pancreat Surg 2019 Aug;23(3):295-9
Published online August 31, 2019;  https://doi.org/10.14701/ahbps.2019.23.3.295
Copyright © 2019 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Ji Su Kim1, Seoung Yoon Rho1,2, Ho Kyoung Hwang1,2, Woo Jung Lee1,2, and Chang Moo Kang1,2

1Division of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, 2Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
Received December 4, 2018; Revised April 20, 2019; Accepted April 20, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 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.
Keywords : Wernicke’s encephalopathy; PPPD; PD; Thiamine deficiency

 

August 2019, 23 (3)