Wernicke's Encephalopathy After Laparoscopic Roux-en-Y Gastric Bypass: a Misdiagnosed Complication

Overview

Journal Obes Surg

Date 2010 Mar 3

PMID 20195787

Citations 16

Authors

Antonio Iannelli

Pietro Addeo

Sebastien Novellas

Jean Gugenheim

Affiliations

Soon will be listed here.

Abstract

Malabsorptive syndromes and micronutrient deficiencies represent well-known long-term complications of bariatric surgery. Wernicke's encephalopathy (WE), a neurologic manifestation of thiamine deficiency, has been classically associated with alcoholism or severe malnutrition, but rarely reported after bariatric surgery. Herein, we describe the case of a 27-year-old woman that developed WE 10 months after laparoscopic Roux-en-Y gastric bypass for morbid obesity that was initially misdiagnosed with a consequent retard in the appropriate treatment. Although only a few sporadic cases have been reported in the literature, all surgeons and physicians involved in the care of bariatric patients must be aware of this potentially serious complication.

Citing Articles

Case Report: Wernicke's encephalopathy after gastric surgery presenting as lactic acidosis and refractory thrombocytopenia.

Lin Q, Li G, Wang Z, Zhang Y Front Surg. 2023; 10:1016347.

PMID: 36896260 PMC: 9989168. DOI: 10.3389/fsurg.2023.1016347.

Prevalence of Postoperative Micronutrient Deficiencies in Bariatric Surgery Patients Who Use Transdermal Patches for Supplementation: A Pilot Study.

Culpepper T, Lux T, Trivedi S, Neal D, Hazen K, Fleisher M Cureus. 2022; 14(6):e25989.

PMID: 35859973 PMC: 9287997. DOI: 10.7759/cureus.25989.

Is Transdermal Multivitamin Patch Effective in Gastric Bypass Patients?.

Saurabh S, Gao Y, Maduka S, Smith L, Lasley R, Singh N Obes Surg. 2019; 29(12):3818-3823.

PMID: 31302845 DOI: 10.1007/s11695-019-04070-5.

Preventing Wernicke Encephalopathy After Bariatric Surgery.

Oudman E, Wijnia J, van Dam M, Biter L, Postma A Obes Surg. 2018; 28(7):2060-2068.

PMID: 29693218 PMC: 6018594. DOI: 10.1007/s11695-018-3262-4.

More than a Case Report? Should Wernicke Encephalopathy After Sleeve Gastrectomy be a Concern?.

Dirani M, Chahine E, Dirani M, Kassir R, Chouillard E Obes Surg. 2017; 27(10):2684-2687.

PMID: 28733807 DOI: 10.1007/s11695-017-2823-2.

References

Schauer P, Ikramuddin S, Gourash W, Ramanathan R, Luketich J . Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000; 232(4):515-29. PMC: 1421184. DOI: 10.1097/00000658-200010000-00007. View

Sechi G, Serra A . Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007; 6(5):442-55. DOI: 10.1016/S1474-4422(07)70104-7. View

Koike H, Misu K, Hattori N, Ito S, Ichimura M, Ito H . Postgastrectomy polyneuropathy with thiamine deficiency. J Neurol Neurosurg Psychiatry. 2001; 71(3):357-62. PMC: 1737557. DOI: 10.1136/jnnp.71.3.357. View

Elliot K . Nutritional considerations after bariatric surgery. Crit Care Nurs Q. 2003; 26(2):133-8. DOI: 10.1097/00002727-200304000-00007. View

Koffman B, Greenfield L, Ali I, Pirzada N . Neurologic complications after surgery for obesity. Muscle Nerve. 2005; 33(2):166-76. DOI: 10.1002/mus.20394. View

Al-Fahad T, Ismael A, Soliman M, Khoursheed M . Very early onset of Wernicke's encephalopathy after gastric bypass. Obes Surg. 2006; 16(5):671-2. DOI: 10.1381/096089206776945075. View

Bozbora A, Coskun H, Ozarmagan S, Erbil Y, Ozbey N, Orham Y . A rare complication of adjustable gastric banding: Wernicke's encephalopathy. Obes Surg. 2000; 10(3):274-5. DOI: 10.1381/096089200321643610. View

DeMaria E . Is gastric bypass superior for the surgical treatment of obesity compared with malabsorptive procedures?. J Gastrointest Surg. 2004; 8(4):401-3. DOI: 10.1016/j.gassur.2003.12.022. View

Madan A, Orth W, Tichansky D, Ternovits C . Vitamin and trace mineral levels after laparoscopic gastric bypass. Obes Surg. 2006; 16(5):603-6. DOI: 10.1381/096089206776945057. View

10.

Escalona A, Perez G, Leon F, Volaric C, Mellado P, Ibanez L . Wernicke's encephalopathy after Roux-en-Y gastric bypass. Obes Surg. 2004; 14(8):1135-7. DOI: 10.1381/0960892041975523. View

11.

Seehra H, Macdermott N, LASCELLES R, Taylor T . Wernicke's encephalopathy after vertical banded gastroplasty for morbid obesity. BMJ. 1996; 312(7028):434. PMC: 2350056. DOI: 10.1136/bmj.312.7028.434. View

12.

Gorecki P, Wise L, Brolin R, Champion J . Complications of combined gastric restrictive and malabsorptive procedures: Part 1. Curr Surg. 2004; 60(2):138-44. DOI: 10.1016/S0149-7944(02)00794-8. View

13.

Calle E, Teras L, Thun M . Obesity and mortality. N Engl J Med. 2005; 353(20):2197-9. DOI: 10.1056/NEJM200511173532020. View

14.

Chaves L, Faintuch J, Kahwage S, Alencar F . A cluster of polyneuropathy and Wernicke-Korsakoff syndrome in a bariatric unit. Obes Surg. 2002; 12(3):328-34. DOI: 10.1381/096089202321088093. View

15.

Martin P, Singleton C, Hiller-Sturmhofel S . The role of thiamine deficiency in alcoholic brain disease. Alcohol Res Health. 2004; 27(2):134-42. PMC: 6668887. View

16.

Nguyen N, Goldman C, Rosenquist C, Arango A, Cole C, Lee S . Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001; 234(3):279-89; discussion 289-91. PMC: 1422019. DOI: 10.1097/00000658-200109000-00002. View

17.

Buffington , Walker , Cowan Jr , Scruggs . Vitamin D Deficiency in the Morbidly Obese. Obes Surg. 1993; 3(4):421-424. DOI: 10.1381/096089293765559142. View

18.

Hubbard , Hall . Gastrointestinal Surgery for Severe Obesity. Obes Surg. 1991; 1(3):257-265. DOI: 10.1381/096089291765560962. View

19.

Toth C, Voll C . Wernicke's encephalopathy following gastroplasty for morbid obesity. Can J Neurol Sci. 2001; 28(1):89-92. DOI: 10.1017/s031716710005263x. View

20.

Bloomberg R, Fleishman A, Nalle J, Herron D, Kini S . Nutritional deficiencies following bariatric surgery: what have we learned?. Obes Surg. 2005; 15(2):145-54. DOI: 10.1381/0960892053268264. View