ABSTRACT
Wernicke syndrome is a rare neurological pathology due to a deficit in vitamin B1. The syndrome is common among alcohol abusers, patients with malignant tumor or gastrointestinal diseases, those who undergo hemodialysis or long-term peritoneal dialysis, pregnant women with hyperemesis, women who breast-feed, patients with hyperthyroidism or anorexia nervosa or gastric or jejunal-ileal bypass surgery for obesity, patients submitted to gastric surgery or prolonged total parenteral nutrition or prolonged intravenous therapy. We report a case of Wernicke syndrome due to afferent loop syndrome characterized by incoercible vomiting.
Subject(s)
Afferent Loop Syndrome/etiology , Gastric Bypass/adverse effects , Wernicke Encephalopathy/etiology , Adenocarcinoma/surgery , Afferent Loop Syndrome/diagnosis , Afferent Loop Syndrome/metabolism , Afferent Loop Syndrome/surgery , Ampulla of Vater/surgery , Anastomosis, Surgical , Brain/pathology , Common Bile Duct Neoplasms/surgery , Digestive System Surgical Procedures , Fatal Outcome , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Stents , Thiamine/pharmacokinetics , Vomiting/etiology , Wernicke Encephalopathy/diagnosis , Wernicke Encephalopathy/pathology , Wernicke Encephalopathy/surgeryABSTRACT
Following gastrectomy, stasis in the afferent jejunal loop accompanied by an overgrowth of bacteria leads to a number of clinical symptoms, including the so-called afferent loop syndrome. The disturbances in intestinal motility may be related to stagnation of the intestinal contents in the afferent loop. The pacemaker cells for the basic contractile activity of the intestine are thought to be the interstitial cells of Cajal (ICCs). We and others have reported that ICCs express the c- kit receptor, and that a decreased number of c- kit-expressing ICCs is generally thought to result in disturbed intestinal motility. We report here a patient with postgastrectomy afferent loop syndrome with a decreased number of c- kit-expressing cells in the external muscle layer of the dilated intestine, suggesting damage to the ICCs.
Subject(s)
Afferent Loop Syndrome/metabolism , Gastroenterostomy/adverse effects , Intestinal Mucosa/metabolism , Proto-Oncogene Proteins c-kit/metabolism , Afferent Loop Syndrome/diagnosis , Barium Sulfate , Endoscopy, Gastrointestinal , Gastrointestinal Motility , Humans , Intestines/cytology , Male , Middle Aged , Reoperation , Stomach Ulcer/surgeryABSTRACT
After gastrectomy and Billroth II anastomosis, if the afferent loop is too long, it may kink and herniate, resulting in obstruction. If it is too short, it may produce acute angulation with obstruction. This condition often simulates acute pancreatitis when the amylase level in urine and serum is increased. Three cases of afferent loop obstruction are reported. The patient who did not undergo laparotomy died; the other two were operated on and survived. The diagnosis, etiology and treatment of these complications are discussed, and similar cases reported in the literature are cited.
