Neuropathic symptoms after sleeve gastrectomy: two cases illustrating diagnostic pitfalls and discordant nerve conduction findings - a case report.

Abstract

Introduction: Peripheral neuropathy is a recognized but often underappreciated complication after sleeve gastrectomy, particularly in patients with rapid weight loss, recurrent vomiting, poor oral intake, and inadequate adherence to postoperative supplementation.

Presentation of case: We describe two young women who developed neuropathic symptoms within 3-4 months of laparoscopic sleeve gastrectomy. Both experienced substantial early weight loss, poor oral intake, recurrent vomiting or regurgitation, and poor adherence to prescribed supplements. Serum vitamin B12 and thiamine levels were elevated in both cases. In the first case, nerve conduction studies demonstrated mild axonal sensorimotor polyneuropathy. In the second, symptoms were neuropathic in character, but lower-limb electrophysiological studies were normal, and interpretation was complicated by spinal imaging abnormalities and interrupted treatment adherence.

Clinical discussion: These cases underscore the limitations of routine serum vitamin measurements in excluding clinically relevant nutritional neuropathy and highlight the importance of considering alternative neurological or musculoskeletal explanations while initiating prompt empirical treatment in high-risk patients.

Conclusion: Early nutritional reassessment and empirical vitamin replacement should be considered in symptomatic patients after sleeve gastrectomy, particularly when poor intake and rapid postoperative weight loss are present.