Abstract
We experienced a case in which right hepatectomy was performed on a hepatocellular carcinoma arising from non-alcoholic steatohepatitis with postoperative complication by Wernickeʼs encephalopathy. The patient was a 62-year-old man. Serum tests for hepatitis B and C were negative. He had been treated for sleep apnea syndrome and diabetes mellitus. His body mass index was 28kg/m2. Tracheotomy was performed due to postoperative respiratory failure. Potassium-free, low calorie fluid was transfused due to hyperkalemia and hyperglycemia after operation. Oral intake was started on postoperative day 33, but disorientation and ataxia were complicated on postoperative day 43. Brain MRI of T2-weighted sequences showed hyperintensity areas symmetrically at medial thalamic lesions along the aqueduct and the third ventricle. Wernickeʼs encephalopathy was diagnosed according to these MRI findings. Vitamin B1 was transfused immediately and symptoms of Wernickeʼs encephalopathy were promptly improved. In this didactic case, the causes of Wernickeʼs encephalopathy were considered to be insufficient replacement of vitamin B1, decrease of coenzyme activity of vitamin B1 due to diabetes mellitus and liver damage, and acceleration of glucose metabolism due to insulin load for diabetes mellitus and hyperglycemia.
