Wernicke encephalopathy following gastrojejunostomy: A case report and review of the literature

Abstract

Introduction: Non-alcoholic Wernicke encephalopathy (WE) is a life-threatening condition, which is caused due to thiamine deficiency. We reported a case of non-alcoholic WE following gastrojejunostomy.

Case presentation: A 31-year-old woman was admitted to our tertiary care center complaining about intractable nausea and vomiting following her gastrojejunostomy. She had undergone gastrojejunostomy because of gastric outlet obstruction after a suicide attempt with scale-remover. Two weeks after gastrojejunostomy, the altered mental status and confusion were reported and she also had a reduced range of motion, dysarthria, generalized muscle weakness, and vertical nystagmus. She gradually became uninterested in surroundings. WE was considered a differential diagnosis, which was confirmed by magnetic resonance imaging (MRI). High-dose intravenous thiamine administration was done for the patient and her symptoms were improved. We also reviewed the PubMed to evaluate studies on WE following gastrointestinal surgeries conducted through the last 10 years.

Conclusion: WE is a rare presentation of gastrojejunostomy and it should be considered as differential diagnosis when patient had impaired mental status and other related WE symptoms following gastrojejunostomy. Early diagnosis and management of WE in the Emergency Department can reduce the mortality and morbidity of WE.

Keywords: Digestive system surgical procedures; Endoscopy; Gastric outlet obstruction; Wernicke encephalopathy.

Fig. 1

A. High signal intensity in FLAIR sequence in the dorsomedial thalami; B. Signal change in the dorsal thalami after a month; C. High signal intensity in FLAIR sequence in the tectal plate and around third ventricle; D. Signal change in the tectal plate and periventricular area after a month; E. High signal intensity in the tectal plate in FLAIR sequence; F. Signal change in the tectal plate after a month.