Tsutsumi Chikanori, Abe Toshiya, Shinkawa Tomohiko, Watanabe Hideyuki, Nishihara Kazuyoshi, Nakano Toru
Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-Ku, Kitakyushu, 802-0077, Japan.
Department of Radiology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan.
Surg Case Rep. 2020 Sep 25;6(1):220. doi: 10.1186/s40792-020-00982-y.
Wernicke's encephalopathy (WE) is an acute neuropsychiatric disorder resulting from thiamine (vitamin B) deficiency, frequently associated with chronic alcoholism and total parenteral nutrition without thiamine. However, only a few reports have focused on the relationship between WE and subtotal stomach-preserving pancreatoduodenectomy (SSPPD).
A 71-year-old woman underwent SSPPD for an adenocarcinoma of the ampulla of Vater. Although there had been no evidence of recurrence, the patient was treated with antibiotics for cholangitis at 12 and 31 months, respectively, post-surgery. Thereafter, the patient presented with vomiting and disorientation 33 months after surgery. Although she was admitted and underwent closer inspection by a neurologist and a psychiatrist, the exact cause of these syndromes remained unknown. The psychiatrist measured thiamine concentration to examine the cause of disorientation. After 6 days, her level of consciousness worsened. Magnetic resonance imaging of the head showed symmetrically multiple abnormal hyperintense signals on fluid-attenuated inversion-recovery and diffusion weighted image, compatible with WE. An administration of intravenous thiamine was immediately initiated. After 8 days of the measurement of the thiamine level, the patient's serum thiamine level was found to be 6 µg/mL (reference range, 24-66 µg/mL). Accordingly, the patient was diagnosed with WE. Shortly after starting the treatment, blood thiamine value reached above normal range with significant improvement of her confusional state. However, short-term memory and ataxia remained.
Development of WE after SSPPD is uncommon. However, to prevent an after-effect, the possibility of development of WE after SSPPD should be recognized.
韦尼克脑病（WE）是一种由硫胺素（维生素B）缺乏引起的急性神经精神障碍，常与慢性酒精中毒和无硫胺素的全胃肠外营养有关。然而，仅有少数报告关注了WE与保留胃的胰十二指肠次全切除术（SSPPD）之间的关系。
一名71岁女性因 Vater壶腹腺癌接受了SSPPD。尽管没有复发迹象，但患者在术后12个月和31个月分别因胆管炎接受了抗生素治疗。此后，患者在术后33个月出现呕吐和定向障碍。尽管她入院并接受了神经科医生和精神科医生的仔细检查，但这些综合征的确切病因仍不清楚。精神科医生测量了硫胺素浓度以检查定向障碍的原因。6天后，她的意识水平恶化。头部磁共振成像显示在液体衰减反转恢复序列和扩散加权图像上有对称的多个异常高信号，符合WE表现。立即开始静脉注射硫胺素。在测量硫胺素水平8天后，发现患者血清硫胺素水平为6μg/mL（参考范围为24 - 66μg/mL）。因此，该患者被诊断为WE。开始治疗后不久，血液硫胺素值达到正常范围以上，其意识模糊状态有显著改善。然而，短期记忆和共济失调仍然存在。
SSPPD后发生WE并不常见。然而，为防止后遗症，应认识到SSPPD后发生WE的可能性。
