title: Copper-deficiency anemia after esophagectomy: A pitfall of postoperative enteral nutrition through jejunostomy.
abstract: BACKGROUND
  Copper deficiency leads to functional disorders of hematopoiesis and neurological system. There have been some reports of copper deficiency occurring to the patients on enteral nutrition through a jejunostomy in long-term-care hospitals. However, it is extremely rare to find patients with copper deficiency several months after esophagectomy, regardless of enteral nutrition through the jejunostomy. To the best of our knowledge, this is the first case report of a patient who experienced copper-deficiency anemia after esophagectomy and subsequent enteral nutrition through the jejunostomy.
  
  
  METHODS
  A 73-year-old man presented with pulmonary failure after esophagectomy for esophageal cancer with video-assisted thoracoscopic surgery, and needed long-term artificial ventilator support. Nutritional management included enteral nutrition through a jejunostomy from the early postoperative period. Copper-deficiency anemia was detected 3 months postoperatively; therefore, copper supplementation with cocoa powder was performed, and both serum copper and hemoglobin levels subsequently recovered.
  
  
  CONCLUSIONS
  Copper-deficiency anemia has already been reported to occur in patients receiving enteral nutrition in long-term care hospitals. However, this is the first case report of copper deficiency after esophagectomy despite administration of standard enteral nutrition through the jejunostomy for several months.
  
  
  CONCLUSIONS
  It is extremely rare to find copper-deficiency anemia several months after esophagectomy followed by enteral nutrition through the jejunostomy. However, if anemia of unknown origin occurs in such patients, copper-deficiency anemia must be considered among the differential diagnoses.
authors.affiliation: Department of Esophagogastric Surgery, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: m-nakagawa.srg2@tmd.ac.jp.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Nakagawa
authors.affiliation: Department of Esophagogastric Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Kagami
authors.initials: K
authors.lastname: Nagai
authors.affiliation: Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Minami
authors.affiliation: Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Mai
authors.initials: M
authors.lastname: Wakabayashi
authors.affiliation: Department of Clinical Nutrition, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Torigoe
authors.affiliation: Department of Esophagogastric Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Tatsuyuki
authors.initials: T
authors.lastname: Kawano
keywords: Cocoa; Copper-deficiency anemia; Enteral nutrition; Esophagectomy; Jejunostomy