Wernicke’s encephalopathy in a patient with severe acute pancreatitis after cholecystectomy and exploration of biliary tract

Background: Wernicke’s encephalopathy (WE) is a disease classically associated with thiamine deficiency，and generally manifests with the triad of opthalmopathy, ataxia and confusion. Only about 20% of the cases can be defined from the relevant literature, with the rest unnoticed and thus unreported. Here, we would like to report a case of a patient with severe acute pancreatitis who suffered from Wernicke’s encephalopathy after cholecystectomy and exploratory of biliary tract. Case presentation: A 37-year-old Chinese male patient diagnosed with severe acute pancreatitis was admitted to our institute’s hospital for further treatment. The patient had a 25-days history of abdominal pain as well as 8-days emesis , and wasn’t addicted in alcohol consumption. He did not receive any regular physical examination or treatment. One months before cholecystectomy and exploratory of biliary tract，he was observed to have abdominal pain ,poor appetite, emesis and sclera icterus .He was referred to the local hospital, received supportive treatment, including antibiotics , parenteral nutrition and liver-protection drugs . However, he got worse after those treatment，so transferred from the local hospital to our hospital for further therapy. After operation he was admitted in general ward for further treatment. When his vital signs and laboratory examination came to stability. He recovered well with supportive treatments, including antibiotics, liver-protection, protecting gastric mucosa and so on. However, his oral intake was too low to support himself, and he was singly dependent on total parenteral nutrition without vitamin B1. On the 7th post-operative day, psychiatric and neurological disorders appeared without an obvious cause, symptoms including babbling, irritability, apathy, non-purposeful movements, and dystaxia. On the basic of his clinical features and brain magnetic resonance imaging scan results, Wernicke encephalopathy was eventually diagnosed. Conclusions: Although extremely rare, this index patient highlights that Wernicke’s encephalopathy could be associated with severe acute pancreatitis. This is very helpful for the therapeutic implications and evaluating curative effect. Thiamine should be provided for patients who have a surgery of cholecystectomy and exploratory of biliary tract so as to prevent and cure Wernicke’s encephalopathy.