Nutritional neuropathy postoesophagogastrectomy

Abstract

We report a case of a patient who presented complaining of a 1-week history of progressive lower limb weakness and decreased sensation bilaterally suggestive of a peripheral neuropathy, with vague associated symptoms of fluctuating concentration. Clinically, we suspected a Guillain-Barré variant. However, her functioning continued to decline despite intravenous immunoglobulin therapy, and she had normal spinal imaging studies and CSF analysis. Of note, she had a subtotal oesophagectomy and proximal gastrectomy 20 months previously for oesophageal cancer. We found her to be deficient in vitamin D, vitamin E and copper. She was treated with nutritional supplementation of these vitamins and infusion of trace elements, resulting in a gradual improvement in lower limb power, sensation and coordination, as well as improved cognition and mentation. Monthly outpatient neurology follow-up shows continued improvement in symptoms and return towards baseline functioning with regular infusions of nutritional elements and monitoring of blood levels.

Keywords: gastrointestinal surgery; malabsorption; oesophageal cancer; peripheral nerve disease; vitamins and supplements.

Figure 1

CT abdomen showing persistent markedly abnormal dilatation of the proximal small bowel.

Figure 2

CT abdomen showing persistent markedly abnormal dilatation of the proximal small bowel.