Wernicke’s encephalopathy following radical gastrectomy and prolonged parenteral nutrition: a case report of pyloric obstruction and undisclosed psychiatric comorbidity

TL;DR

A 64-year-old man developed Wernicke’s encephalopathy after surgery and prolonged nutrition therapy, highlighting the need for careful nutritional and psychiatric care in cancer patients.

Contribution

This is the first reported case of WE following radical gastrectomy and prolonged TPN in a patient with gastric cancer and undisclosed psychiatric issues.

Findings

WE occurred 20 days after gastrectomy due to thiamine-free TPN and delayed enteral intake.

Timely thiamine supplementation and MRI confirmed the diagnosis and led to full neurological recovery.

Multidisciplinary care ensured sustained psychiatric and neurological stability during chemotherapy.

Abstract

Wernicke’s encephalopathy (WE), a neuropsychiatric emergency caused by thiamine deficiency, is increasingly recognized in nonalcoholic populations. We present a 64-year-old male with pyloric obstruction from gastric cancer (stage IIIA) who developed WE 20 days after gastrectomy. Prolonged thiamine-free total parenteral nutrition (TPN), delayed enteral intake, and cancer-related hypermetabolism jointly precipitated a thiamine deficiency. Undisclosed psychiatric comorbidity exacerbated diagnostic challenges and potential risk. Despite initial diagnostic challenges, timely neurological assessment and urgent brain MRI confirmed the diagnosis on the day of readmission. Immediate thiamine supplementation led to full neurological recovery. At six-month follow-up, the patient remained neurologically intact with structured dietary and psychological counseling, ensuring sustained psychiatric stability during adjuvant chemotherapy. This novel case of WE following radical gastrectomy, prolonged TPN, and in the context of gastric cancer with pyloric obstruction and undisclosed psychiatric comorbidity, underscores the necessity of multidisciplinary collaboration to optimize perioperative nutritional and psychosocial management in high-risk oncological surgical populations.

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