[Hepatic encephalopathy following a Whipple operation]

Area of Science:

• Gastroenterology and Hepatology
• Surgical Oncology

Background:

• Pancreaticoduodenectomy (Whipple procedure) is a major surgery for pancreatic head adenocarcinoma.
• Postoperative complications can include endocrine and exocrine insufficiency.
• Non-alcoholic fatty liver disease (NAFLD) is a potential, under-recognized late complication.

Observation:

• A 65-year-old female presented with confusion and hypersomnia, progressing to coma.
• Hepatic encephalopathy was diagnosed as the cause of her comatose state.
• She had a history of pancreaticoduodenectomy 15 years prior for pancreatic head adenocarcinoma.

Findings:

• The patient developed secondary exocrine pancreas insufficiency and fatty liver post-surgery.
• Non-alcoholic fatty liver disease (NAFLD) was identified as a complication, potentially linked to exocrine insufficiency.
• NAFLD progressed to non-alcoholic steatohepatitis (NASH), leading to liver cirrhosis and hepatic encephalopathy.

Implications:

• This case represents the first report of hepatic encephalopathy as liver failure secondary to NASH after pancreaticoduodenectomy.
• Highlights the importance of monitoring for NAFLD and its progression in patients post-Whipple procedure.
• Suggests a potential link between exocrine pancreatic insufficiency and the development of NAFLD.