CASE PRESENTATION: A 71-year-old woman underwent SSPPD for an
adenocarcinoma of the ampulla of Vater. Although there had been no evidence of recurrence, the patient was treated with
antibiotics for
cholangitis at 12 and 31 months, respectively, post-surgery. Thereafter, the patient presented with
vomiting and disorientation 33 months after surgery. Although she was admitted and underwent closer inspection by a neurologist and a psychiatrist, the exact cause of these syndromes remained unknown. The psychiatrist measured
thiamine concentration to examine the cause of disorientation. After 6 days, her level of consciousness worsened. Magnetic resonance imaging of the head showed symmetrically multiple abnormal hyperintense signals on fluid-attenuated inversion-recovery and diffusion weighted image, compatible with WE. An administration of intravenous
thiamine was immediately initiated. After 8 days of the measurement of the
thiamine level, the patient's serum
thiamine level was found to be 6 µg/mL (reference range, 24-66 µg/mL). Accordingly, the patient was diagnosed with WE. Shortly after starting the treatment, blood
thiamine value reached above normal range with significant improvement of her
confusional state. However, short-term memory and
ataxia remained.
CONCLUSIONS: Development of WE after SSPPD is uncommon. However, to prevent an after-effect, the possibility of development of WE after SSPPD should be recognized.