Wernicke's Encephalopathy Postoperatively for a Gastric Tumor: A Pathology which could be Confused with Postoperative Peritonitis

Background: Wernicke's encephalopathy is a neurological syndrome secondary to a thiamine deficiency which is a cofactor for several biochemical reactions in the brain. In the postoperative context, this condition is often underdiagnosed, especially in patients admitted to intensive care given the non-specificity of neurological symptoms which can often have multifactorial origins in this type of patient. We report the case of a patient with Wernicke syndrome postoperatively after a cancer gastrectomy and whose clinical symptoms were initially confused with postoperative peritonitis. Case presentation: An 78-year-old female patient, initially admitted to the gastrology for treatment of late post-prandial vomiting associated with weight loss. An esophago-gastro-duodenal fibroscopy was performed and revealed a stenosis and impassable mass at the antro-pyloric level. The patient was placed on parenteral undernutrition and rehydration. The pathological examination came back in favor of a moderately differentiated, ulcerated and invasive gastric adenocarcinoma. The indication for oncological gastrectomy was made after multidisciplinary consultation. On the 15th postoperative day, the patient was admitted to the emergency department of our hospital with a clinical presentation of evisceration. The patient was put on rehydration with potassium recharge as well as dual antibiotic therapy before her admission to the operating room for surgical treatment of her evisceration. The evolution was marked by installation on the fourth postoperative day of confusion associated with agitation. Postoperative peritonitis was strongly suspected, but given the atypia of the neurological disorder, a brain CT was performed, returning without abnormalities. An additional MRI was carried out revealing a T2 flair hypersignal and periaqueductal diffusion and mammillary bodies, compatible with Gayet Wernicke syndrome. Conclusion: Patients with advanced gastric cancer are at risk ...