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

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 ble...

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Detalles Bibliográficos
Autores principales: Kim, Ji Su, Rho, Seoung Yoon, Hwang, Ho Kyoung, Lee, Woo Jung, Kang, Chang Moo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Association of Hepato-Biliary-Pancreatic Surgery 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728253/
https://www.ncbi.nlm.nih.gov/pubmed/31501822
http://dx.doi.org/10.14701/ahbps.2019.23.3.295
Descripción
Sumario: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.