Abstract
We report a case of night blindness due to vitamin A deficiency after subtotal stomach-preserving pancreaticoduodenectomy (SSPPD), that might be caused by intra-hepatic bile duct stones, obstructive jaundice and chronic cholangitis secondary to strictures of choledocho-jejuno anastmosis.
The patient was a 73-year-old woman who underwent SSPPD for intraductal papillary mucinous neoplasms (IPMN) three years earlier. One year after SSPPD, she developed strictures of choledocho-jejuno anastomosis, multiple intra-hepatic bile duct stones and obstructive jaundice, and had had recurrent bouts of chronic cholangitis for these two years.
This time, she was hospitalized because of acute cholangitis. Percutaneous transhepatic cholangiodrainage, percutaneous transhepatic cholangioscopic lithotomy and balloon dilatation of the anastomosis improved cholangitis and obstructive jaundice. She also had been suffered from night blindness due to vitamin A deficiency. After intramuscular injection of vitamin A, night blindness improved immediately.
It was speculated that both malabsorption of fat-soluble vitamins according to insufficiency of bile secretion and liver dysfunction due to obstructive jaundice might cause vitamin A deficiency.
