SUCCESSFUL SURGICAL-TREATMENT OF SECONDARY KWASHIORKOR AFTER TOTAL GASTRECTOMY - REPORT OF A CASE

We report herein the case of a 56-year-old woman who developed seconda ry Kwashiorkor 9 years after undergoing a total gastrectomy for early gastric cancer. Until she began developing the symptoms of Kwashiorkor , including general fatigue, edema of the face and extremities, anemia , alopecia, and weight loss, she had been leading a normal life post-g astrectomy. Her symptoms were alleviated by total parenteral nutrition (TPN) therapy, but reappeared soon after TPN therapy was discontinued . Therefore, she required several subsequent courses of TPN. Tn an att empt to permanently resolve the ongoing Kwashiorkor symptoms, reconstr uctive surgery involving transposition of the jejunum from the previou s Graham method to the interposition method was performed 10 years aft er the initial gastrectomy. After the second operation, her malnutriti on was completely alleviated, and she has been in good health for the 8 years since. To our knowledge, there has been no other report of the symptoms of secondary Kwashiorkor after total gastrectomy being allev iated by altering the procedure of reconstruction of the intestinal tr act. Thus, we recommend surgical treatment to alter the digestive cont inuity to a more physiological pathway for selected patients with seco ndary Kwashiorkor syndrome.