title: Wernicke encephalopathy as rare complication of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
abstract: BACKGROUND
  Peritoneal carcinomatosis of gastric origin is a frequent event with poor survival. A new promising approach is the association of the Cytoreductive Surgery (CRS) with the Hyperthermic Intraperitoneal Chemotherapy (HIPEC), which yet is characterized by high morbidity and mortality. We report, to our knowledge, the first case of Wernicke Encephalopathy (WE) complicating CRS plus HIPEC. WE, caused by a deficiency of thiamine, is characterized by ataxia, ocular motor cranial neuropathies and changes in consciousness.
  
  
  METHODS
  A patient affected by gastric cancer with peritoneal seeding, submitted to CRS plus HIPEC, in 4th post-operative day had manifested the appearance of flapping tremors, with positive manoeuvre of Mingazzini, impaired vision and mental confusion. The brain Magnetic Resonance Imaging (MRI) confirmed the clinical suspicion of WE. Even though the appropriate therapy was promptly applied, the patient died in 10th post-operative day.
  
  
  CONCLUSIONS
  WE is an uncommon neurological disorder. Only 16% of these patients inadequately treated recover fully, with a mortality rate of 10-20%. We consider useful to report this case, because it is the first time that WE is correlated to CRS plus HIPEC.
authors.affiliation: Department of Human Pathology, University of Messina, Via Consolare Valeria, 98125 Messina, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Macrì
authors.affiliation: Department of Human Pathology, University of Messina, Via Consolare Valeria, 98125 Messina, Italy. Electronic address: franz.fleres@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fleres
authors.affiliation: Department of Human Pathology, University of Messina, Via Consolare Valeria, 98125 Messina, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ieni
authors.affiliation: Department of Human Pathology, University of Messina, Via Consolare Valeria, 98125 Messina, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rossitto
authors.affiliation: Anesthesiology and Neuroreanimation Unit, University of Messina, Via Consolare Valeria, 98125 Messina, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Mandolfino
authors.affiliation: Anesthesiology and Neuroreanimation Unit, University of Messina, Via Consolare Valeria, 98125 Messina, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Micalizzi
authors.affiliation: Department of Human Pathology, University of Messina, Via Consolare Valeria, 98125 Messina, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Iaropoli
authors.affiliation: Department of Human Pathology, University of Messina, Via Consolare Valeria, 98125 Messina, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Mazzeo
authors.affiliation: Department of Human Pathology, University of Messina, Via Consolare Valeria, 98125 Messina, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Trovato
authors.affiliation: Department of Human Pathology, University of Messina, Via Consolare Valeria, 98125 Messina, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Cucinotta
authors.affiliation: Department of Human Pathology, University of Messina, Via Consolare Valeria, 98125 Messina, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Saladino
keywords: Complications; Gastric cancer; HIPEC; Peritoneal carcinomatosis; Wernicke Encephalopathy