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Wernicke’s encephalopathy, refeeding syndrome and wet beriberi after laparoscopic sleeve gastrectomy: the importance of thiamine evaluation


We described the case of a young man with morbid obesity who underwent bariatric surgery who experiences different complications. After the discharge the patient starts to complain about nausea, dizziness, and visual impairment. After a first access to an emergency department, with a diagnosis of labyrinthopathy, the patient gets worse. He then has been hospitalized and a wernicke’s encephalopathy was diagnosed. During the hospitalization other comploication of low thiamine appeared such as wet beriberi. The clinical picture was also complicated with the refeeding syndrome. Wernicke’s encephalopathy, wet beriberi, and refeeding syndrome are life-threatening conditions that can be prevented and treated. Both physicians and patients must be warned about these potential risks in order to put in act a prompt treatment.

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Fig. 1: MRI Flair.
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  1. WHO. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. WHO technical Report Series 894. Geneva: Wolrld Health Organization; 2000.

  2. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide. 2011. Obes Surg. 2013;23:427–36.

    Article  Google Scholar 

  3. Gumbs AA, Gagner M, Dakin D, Pomp A. Sleeve gastrectomy for morbid obesity. Obes Surg. 2007;17:962–9.

    Article  Google Scholar 

  4. Boza C, Salinas J, Salgado N, Pérez G, Raddatz A, Funke R, et al. Laparoscopic sleeve gastrectomy as a stand-alone procedure for morbid obesity: report of 1000 cases and 3-years follow-up. Obes Surg. 2012;22:866–71.

    Article  Google Scholar 

  5. Koffman BM, Greenfield J, Ali II, Pirzada NA. Neurologic complications after surgery for obesity. Muscle Nerve. 2006;33:166–76.

    Article  Google Scholar 

  6. Tabbara M, Carandina S, Bossi M, Polliand C, Genser L, Barrat C. Rare neurological complications after sleeve gastrectomy. Obes Surg. 2016;26:2843–8.

    Article  Google Scholar 

  7. Pacei F, Mullin S, Colombo C, Viganò S, Bet L. A case of Wernicke’s encephalopathy due to oesophageal achalasia. Neurol Sci. 2013;34:799–800.

    Article  Google Scholar 

  8. Gehrer S, Kern B, Peters T, Christoffel-Courtin C, Peterli R. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy than after laparoscopic Roux-Y-gastric bypass (LRYGB) a prospective study. Obes Surg. 2010;20:447–53.

    Article  Google Scholar 

  9. Singh S, Kumar A. Wernicke encephalopathy after obesity surgery: a systematic review. Neurology. 2007;68:807–11.

    Article  Google Scholar 

  10. Becker DA, Balcer LJ, Galetta SL. The neurological complications of nutritional deficiency following bariatric surgery. J Obes. 2012;2012:608534.

    Article  Google Scholar 

  11. Davies DJ, Baxter JM, Baxter JN. Nutritional deficiencies after bariatric surgery. Obes Surg 2007;17:1150–8.

    Article  CAS  Google Scholar 

  12. Kaidar-Person O, Person B, Szomstein S, Rosenthal RJ. Nutritional deficiencies in morbidly obese patients: a newform of malnutrition? Part a: vitamins. Obes Surg. 2008;18:870–6.

    Article  Google Scholar 

  13. Sechi G, Serra A. Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007;6:442–55.

    Article  CAS  Google Scholar 

  14. Sharabi S, Bisharat N. Wernicke encephalopathy after sleeve gastrectomy. Isr Med Assoc J. 2012;14:708–9.

    PubMed  Google Scholar 

  15. Milone M, Velotti N, Musella M. Wernicke encephalopathy following laparoscopic sleeve gastrectomy-a call to evaluate thiamine deficiencies after restrictive bariatric procedures. Obes Surg. 2018;28:852–3.

    Article  Google Scholar 

  16. Truong J, Shalchian S, Maertens de Noordhout A, Fumal A. About a case of Wernicke’s encephalopathy after sleeve gastrectomy. Eat Weight Disord. 2016;21:721–3.

    Article  CAS  Google Scholar 

  17. Athanasiou A, Spartalis E, Moris D, Alexandrou A, Liakakos T. Sleeve gastrectomy and Wernicke encephalopathy. Am J Ther. 2017;24:e504–5.

    Article  Google Scholar 

  18. Dirani M, Chahine E, Dirani M, Kassir R, Chouillard E. More than a Case report? Should Wernicke encephalopathy after sleeve gastrectomy be a concern? Obes Surg. 2017;27:2684–7.

    Article  Google Scholar 

  19. Leslie A, Hamilton LA, Darby SH, Hamilton AJ, Wilkerson MH, Morgan KA. Case report of Wernicke’s encephalopathy after sleeve gastrectomy. Nutr Clin Pract. 2018;33:510–4.

    Google Scholar 

  20. Scarano V, Milone M, Di Minno MN, Panariello G, Bertogliatti S, Terracciano M, et al. Late micronutrient deficiency and neurological dysfunction after laparoscopic sleeve gastrectomy: a case report. Eur J Clin Nutr. 2012;66:645–7.

    Article  CAS  Google Scholar 

  21. Kröll D, Laimer M, Borbély YM, Laederach K, Candinas D, Nett PC. Wernicke encephalopathy: a future problem even after sleeve gastrectomy? A systematic literature review. Obes Surg. 2016;26:205–12.

    Article  Google Scholar 

  22. Pardo-Aranda F, Perez-Romero N, Osorio J, Rodriguez-Santiago J, Muñoz E, Puértolas N, et al. Wernicke’s encephalopathy after sleeve gastrectomy: literature review. Int J Surg Case Rep. 2016;20:92–5.

    Article  Google Scholar 

  23. Gasquoine PG. A case of bariatric surgery-related Wernicke-Korsakoff Syndrome with persisting anterograde amnesia. Arch Clin Neuropsychol. 2017;32:610–7.

    Article  Google Scholar 

  24. Moizé V, Ibarzabal A, Sanchez Dalmau B, Flores L, Andreu A, Lacy A, et al. Nystagmus: an uncommon neurological manifestation of thiamine deficiency as a serious complication of sleeve gastrectomy. Nutr Clin Pract. 2012;27:788–92.

    Article  Google Scholar 

  25. Jeong HJ, Park JW, Kim YJ, Lee YG, Jang YW, Seo JW. Wernicke’s encephalopathy after sleeve gastrectomy for morbid obesity—a case report. Ann Rehabil Med. 2011;35:583–6.

    Article  Google Scholar 

  26. Manzo G, De Gennaro A, Cozzolino A, Serino A, Fenza G, Manto A. MR imaging findings in alcoholic and nonalcoholic acute Wernicke’s encephalopathy: a review. Biomed Res Int. 2014;2014:503596.

    Article  Google Scholar 

  27. Friedli N, Stanga Z, Sobotka L, Culkin A, Kondrup J, Laviano A, et al. Revisiting the refeeding syndrome: results of a systematic review. Nutrition. 2017;35:151–60.

    Article  Google Scholar 

  28. Mehanna HM, Jamil M, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it. BMJ. 2008;336:1495–8.

    Article  Google Scholar 

  29. DiNicolantonio JJ, Liu J, O’Keefe JH. Thiamine and cardiovascular disease: a literature review. Prog Cardiovasc Dis. 2018;61:27–32.

    Article  Google Scholar 

  30. Galvin R, Brathen G, Ivashynka A, Hillbom M, Tanasescu R, Leone MA, EFNS. EFNS guidelines for the diagnosis, therapy and prevention of Wernicke’s encephalopathy. Eur J Neurol. 2010;17:1408–18.

    Article  CAS  Google Scholar 

  31. Srinivasa S, Hill LS, Sammour T, Hill AG, Babor R, Rahman H. Early and mid-term outcomes of single stage laparoscopic sleeve gastrectomy. Obes Surg. 2010;20:1484–90.

    Article  Google Scholar 

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Pacei, F., Iaccarino, L., Bugiardini, E. et al. Wernicke’s encephalopathy, refeeding syndrome and wet beriberi after laparoscopic sleeve gastrectomy: the importance of thiamine evaluation. Eur J Clin Nutr 74, 659–662 (2020).

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