Obesity Surgery

, Volume 20, Issue 11, pp 1594–1596 | Cite as

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

  • Antonio Iannelli
  • Pietro Addeo
  • Sebastien Novellas
  • Jean Gugenheim
Case Report

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.

Keywords

Wernicke's encephalopathy Bariatric surgery Vomiting Thiamine deficiency Gastric bypass 

Notes

Conflict of Interest Disclosure

The authors declare that they have no conflict of interest.

References

  1. 1.
    Calle EE, Teras LR, Thun MJ. Obesity and mortality. N Engl J Med. 2005;353:2197–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Hubbard VS, Hall WH. Gastrointestinal surgery for severe obesity. Obes Surg. 1991;1:257–65.CrossRefPubMedGoogle Scholar
  3. 3.
    DeMaria EJ. Is gastric bypass superior for the surgical treatment of obesity compared with malabsorptive procedures? J Gastrointest Surg. 2004;8:401–3.CrossRefPubMedGoogle Scholar
  4. 4.
    Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234:279–89. discussion 289–91.CrossRefPubMedGoogle Scholar
  5. 5.
    Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232:515–29.CrossRefPubMedGoogle Scholar
  6. 6.
    Elliot K. Nutritional considerations after bariatric surgery. Crit Care Nurs Q. 2003;26:133–8.PubMedGoogle Scholar
  7. 7.
    Sechi G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007;6:442–55.CrossRefPubMedGoogle Scholar
  8. 8.
    Koffman BM, Greenfield LJ, Ali II, et al. Neurologic complications after surgery for obesity. Muscle Nerve. 2006;33:166–76.CrossRefPubMedGoogle Scholar
  9. 9.
    Bloomberg RD, Fleishman A, Nalle JE, et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005;15:145–54.CrossRefPubMedGoogle Scholar
  10. 10.
    Buffington C, Walker B, Cowan Jr GS, et al. Vitamin D deficiency in the morbidly obese. Obes Surg. 1993;3:421–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Madan AK, Orth WS, Tichansky DS, et al. Vitamin and trace mineral levels after laparoscopic gastric bypass. Obes Surg. 2006;16:603–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Koike H, Misu K, Hattori N, et al. Postgastrectomy polyneuropathy with thiamine deficiency. J Neurol Neurosurg Psychiatry. 2001;71:357–62.CrossRefPubMedGoogle Scholar
  13. 13.
    Martin PR, Singleton CK, Hiller-Sturmhofel S. The role of thiamine deficiency in alcoholic brain disease. Alcohol Res Health. 2003;27:134–42.PubMedGoogle Scholar
  14. 14.
    Chaves LC, Faintuch J, Kahwage S, et al. A cluster of polyneuropathy and Wernicke–Korsakoff syndrome in a bariatric unit. Obes Surg. 2002;12:328–34.CrossRefPubMedGoogle Scholar
  15. 15.
    Mancall E. Nutritional disorders of nervous system. 3rd ed. New York: Churchill-Livingstone; 2001.Google Scholar
  16. 16.
    Toth C, Voll C. Wernicke's encephalopathy following gastroplasty for morbid obesity. Can J Neurol Sci. 2001;28:89–92.PubMedGoogle Scholar
  17. 17.
    Seehra H, MacDermott N, Lascelles RG, et al. Wernicke's encephalopathy after vertical banded gastroplasty for morbid obesity. BMJ. 1996;312:434.PubMedGoogle Scholar
  18. 18.
    Bozbora A, Coskun H, Ozarmagan S, et al. A rare complication of adjustable gastric banding: Wernicke's encephalopathy. Obes Surg. 2000;10:274–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Gorecki P, Wise L, Brolin RE, et al. Complications of combined gastric restrictive and malabsorptive procedures: part 1. Curr Surg. 2003;60:138–44.CrossRefPubMedGoogle Scholar
  20. 20.
    Al-Fahad T, Ismael A, Soliman MO, et al. Very early onset of Wernicke's encephalopathy after gastric bypass. Obes Surg. 2006;16:671–2.CrossRefPubMedGoogle Scholar
  21. 21.
    Escalona A, Perez G, Leon F, et al. Wernicke's encephalopathy after Roux-en-Y gastric bypass. Obes Surg. 2004;14:1135–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • Antonio Iannelli
    • 1
    • 2
    • 3
  • Pietro Addeo
    • 1
    • 2
    • 3
  • Sebastien Novellas
    • 4
  • Jean Gugenheim
    • 1
    • 2
    • 3
  1. 1.Service de Chirurgie Digestive et Centre de Transplantation Hepatique, Hopital Archet 2Nice Cedex 3France
  2. 2.Centre Hospitalier Universitaire de Nice, Pôle DigestifNiceFrance
  3. 3.Faculté de MédecineUniversité de Nice-Sophia-AntipolisNiceFrance
  4. 4.Service d’Imagerie diagnostique et Interventionelle, Hopital Archet 2Nice Cedex 3France

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