CASE REPORT article
Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1595004
Wernicke's encephalopathy following radical gastrectomy and prolonged parenteral nutrition: a case report of pyloric obstruction and undisclosed psychiatric comorbidity
Provisionally accepted
Hanchen Ma1,2
Zheng Zhao1,2
Wenjie Zhang3,4
Shuaichen Jin1,2
Linchuan Li3,4Ruizhao Zong3,4Xueyu Fu3,4Yingjie Sun3,4
Yunmiao Pan1,2Jiankang Zhu3,4*
Guangyong Zhang3,4*- 1Shandong University, Jinan, China
- 2Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
- 3Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- 4Laboratory of Metabolism and Gastrointestinal Tumor, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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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 replacement 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.
Keywords: Wernicke's encephalopathy, gastric cancer, Thiamine, Parenteral Nutrition, Psychiatric comorbidity
Received: 18 Mar 2025; Accepted: 09 Jun 2025.
Copyright: © 2025 Ma, Zhao, Zhang, Jin, Li, Zong, Fu, Sun, Pan, Zhu and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jiankang Zhu, Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
Guangyong Zhang, Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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