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Refeeding Syndrome after Gastrectomy in a Patient with Hypophosphatemia: A Case Report
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Cheong Ah Oh
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Ann Clin Nutr Metab 2022;14(2):88-92. Published online December 1, 2022
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DOI: https://doi.org/10.15747/ACNM.2022.14.2.88
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 Abstract
 PDF ePub
- This study describes an 81-year-old male who was highly suspicious for refeeding syndrome (RFS) after a retrospective review of his postoperative clinical progression. This highlights the importance of clinicians’ awareness of the possibility of RFS development in surgical patients with any RFS risk factors.
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Development of Wernicke’s Encephalopathy during Total Parenteral Nutrition Therapy without Additional Multivitamin Supplementation in a Patient with Intestinal Obstruction: A Case Report
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Cheong Ah Oh
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Ann Clin Nutr Metab 2022;14(2):93-96. Published online December 1, 2022
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DOI: https://doi.org/10.15747/ACNM.2022.14.2.93
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Abstract
PDFePub
- Wernicke’s encephalopathy (WE) is a serious neurological disorder that can be fatal if not properly treated. In this current paper, I present the case of a 51-year-old male with a perivesical fistula between a presacral abscess and the rectus abdominis muscle. He received total parenteral nutrition therapy during a fasting period because of small bowel obstruction and later developed WE. The patient’s WE-related symptoms improved following rapid treatment with high doses of thiamine.
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Pathogenesis, risk factors, and management of postoperative delayed gastric emptying after distal gastrectomy: a narrative review
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Cheong Ah Oh
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Received February 13, 2025 Accepted March 26, 2025 Published online March 31, 2025
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DOI: https://doi.org/10.15747/ACNM.25.0007
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Abstract
ePub
- Purpose
This narrative review elucidates the complex pathogenesis, key risk factors, and effective management strategies for postoperative delayed gastric emptying (DGE) following distal gastrectomy with D2 lymphadenectomy, a definitive procedure for middle and lower gastric cancer. It also explores opportunities for improved prevention and innovative treatment options.
Current concept: DGE significantly disrupts gastric motility and presents with symptoms such as early satiety, postprandial fullness, nausea, vomiting, and gastric atony. Although rarely fatal, DGE hampers oral intake, prolongs hospital stays, and diminishes quality of life. Current evidence indicates that DGE is a multifactorial disorder resulting from an interplay of vagal nerve disruption, damage to smooth muscle and interstitial cells of Cajal, imbalances in gastrointestinal hormones, and postoperative gut microbiome dysbiosis. Patient-specific factors, including advanced age, poor nutritional status, diabetes, and preoperative pyloric obstruction, along with surgical factors (most notably Billroth II reconstruction), further increase the risk of DGE. Management involves dietary modifications, prokinetic agents (such as metoclopramide and selective 5-HT4 agonists like prucalopride), and gastric decompression.
Conclusion
DGE is a challenging complication following gastrectomy that demands a deeper understanding of its underlying mechanisms to improve patient outcomes. Emerging therapies, including microbiota modulation and advanced pharmacological agents, offer promising new treatment avenues.
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