Abstract
We report herein the case of a 56-year-old woman who developed secondary Kwashiorkor 9 years after undergoing a total gastrectomy for early gastric cancer. Until she began developing the symptoms of Kwashiorkor, including general fatigue, edema of the face and extremities, anemia, alopecia, and weight loss, she had been leading a normal life post-gastrectomy. Her symptoms were alleviated by total parenteral nutrition (TPN) therapy, but reappeared soon after TPN therapy was discontinued. Therefore, she required several subsequent courses of TPN. In an attempt to permanently resolve the ongoing Kwashiorkor symptoms, reconstructive surgery involving transposition of the jejunum from the previous Graham method to the interposition method was performed 10 years after the initial gastrectomy. After the second operation, her malnutrition was completely alleviated, and she has been in good health for the 8 years since. To our knowledge, there has been no other report of the symptoms of secondary Kwashiorkor after total gastrectomy being alleviated by altering the procedure of reconstruction of the intestinal tract. Thus, we recommend surgical treatment to alter the digestive continuity to a more physiological pathway for selected patients with secondary Kwashiorkor syndrome.
Similar content being viewed by others
References
Adams JM (1967) The clinical and metabolic consequences of total gastrectomy. Scand J Gastroenterol 2:137–149
Graham RR (1940) A technique for total gastrectomy. Surgery 8:257–264
Moreno AG (1956) Studies on nutritional and other disturbances following operations for cancer of the stomach. Ann Surg 144:779–808
Cristallo M, Braga M, Agape D, Primignani M, Zuliani W, Vecchi M, Murone M, Sironi M, Di Carlo V, De Franchis R (1986) Nutritional status, function of the small intestine and jejunal morphology after total gastrectomy for carcinoma of the stomach. Surg Gynecol Obstet 163:225–230
Krikler DM, Schripe V (1958) “Kwashiorkor” in an adult due to an intestinal blind loop. Lancet 1:510–511
Leitner ZA (1958) Postoperative malabsorption — secondary protein malnutrition syndrome —. Lancet 2:504–507
Zelnick R, Augste LJ, Wise L (1989) Nutritional effect of postgastrectomy reconstruction: a clinical evaluation. J Surg Oncol 40:219–221
Armbrecht U, Lundell L, Lindstedt G, Stockbruegger RW (1988) Causes of malabsorption after total gastrectomy with Roux-en-Y reconstruction. Acta Chir Scand 154:37–41
Lundh G (1962) The mechanism of postgastrectomy malabsorption. Gastroenterology 42:637–640
Bradley III EL, Isaacs J, Hersh T, Davidson ED, Millikan W (1975) Nutritional consequences of total gastrectomy. Ann Surg 182:415–429
Donovan IA, Fielding JW, Bradby H, Sorgi M, Harding LK (1982) Bile diversion after total gastrectomy. Br J Surg 69:389–390
Rossouw J (1989) Kwashiorkor in North America. Am J Clin Nutr 49:588–592
Gullo L, Costa PL, Ventrucci M, Mattioli S, Viti G, Labò G (1979) Exocrine pancreatic function after gastrectomy. Scand J Gastroenterol 14:401–407
Kumei Y, Minemoto H, Ueda N, Takasugi Y, Namiki M (1982) A case study of secondary Kwashiorkor syndrome well treated with an enteral alimentary diet (in Japanese). Tan to Sui (J Biliary Tract Pancreas) 3:1609–1614
Sasagawa T, Karasawa K, Ogoshi K, Kimura A, Fujinaka Y, Tashiro S, Kinoshita Y, Inui M (1968) The treatment of secondary Kwashiorkor after gastrectomy by per oral administration of multiple amino acids (in Japanese). Kanzou (Acta Hepatol Japonica) 9:53–57
Huguier M, Lancret JM, Bernard PF, Baschet C, Le Henand F (1976) Functional result of different reconstructive procedures after total gastrectomy. Br J Surg 63:704–708
Bradley III EL, Isaacs JT, Del Mazo J, Hersh T (1977) Pathophysiology and significance of malabsorption after Rouxen-Y reconstruction. Surgery 81:684–691
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kadowaki, A., Tajima, T., Kogure, H. et al. Successful surgical treatment of secondary kwashiorkor after total gastrectomy: Report of a case. Surg Today 25, 548–551 (1995). https://doi.org/10.1007/BF00311313
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00311313