A Case of Severe Malnutrition Successfully Treated with Pancrelipase 6.5 Years after Gastrectomy for Gastric Cancer

Abstract

A 67-year-old man with a history of laparoscopic distal gastrectomy and Roux-en-Y reconstruction for gastric cancer 6.5 years earlier was admitted with severe malnutrition (BMI 14.3 kg/m², weight 40 kg), leg edema, pleural effusion, and ascites. Laboratory tests showed hypoalbuminemia (Alb 1.3 g/dL) and a low prognostic nutritional index (PNI 18.5). Despite central venous nutrition, his condition did not improve. Secondary exocrine pancreatic insufficiency (EPI) after gastrectomy was suspected, and pancreatic enzyme replacement therapy (PERT) with pancrelipase was started. After one month, Alb increased to 2.2 g/dL and PNI to 34.7, allowing discharge. Three months later, his weight increased to 47.2 kg, and after one year, Alb reached 4.1 g/dL and PNI 51.3. This case suggests that, when postoperative malnutrition after gastrectomy does not respond to nutritional guidance or supplementation, secondary EPI should be considered, and pancrelipase may be a useful treatment option.