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An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function

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Nutritional neuropathy postoesophagogastrectomy.

Paul Ryan¹, Peter Kinirons²

¹Anaesthesia/Intensive Care, Tallaght University Hospital, Dublin, Ireland pauljeromeryano30@gmail.com.

BMJ Case Reports

|May 27, 2021

Summary

A patient with progressive neurological decline after cancer surgery improved with nutritional supplementation. Deficiencies in vitamin D, vitamin E, and copper were identified and treated, restoring neurological function.

Keywords:

gastrointestinal surgery malabsorption oesophageal cancer peripheral nerve disease vitamins and supplements

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Area of Science:

Neurology
Nutritional Neuroscience
Gastroenterology

Background:

A patient presented with progressive lower limb weakness and sensory loss, initially suspected as a Guillain-Barré variant.
Standard treatments and diagnostic tests, including spinal imaging and CSF analysis, were ineffective.
The patient had a history of subtotal oesophagectomy and proximal gastrectomy for oesophageal cancer.

Observation:

Neurological deficits persisted despite initial treatment.
The patient was found to be deficient in vitamin D, vitamin E, and copper.
These deficiencies were identified 20 months post-surgery.

Findings:

Nutritional supplementation with vitamin D, vitamin E, and copper, along with trace element infusions, led to significant neurological improvement.
Cognitive function and mentation also improved with supplementation.
This suggests a link between nutrient deficiencies and neurological symptoms in this patient.

Implications:

Nutritional deficiencies can manifest as severe neurological symptoms, mimicking autoimmune neuropathies.
Post-gastric and oesophageal surgery patients require careful monitoring for vitamin and mineral deficiencies.
Prompt diagnosis and supplementation of specific nutrients can reverse neurological deficits and improve quality of life.