INTRODUCTION: Wernicke's encephalopathy (WE) is a neurological syndrome caused 
by thiamine deficiency, and clinically characterized by ophthalmoplegia, ataxia 
and acute confusion. In developed countries, most cases of WE have been seen in 
alcohol misusers. Other reported causes are gastrointestinal tract surgery, 
hyperemesis gravidarum, chronic malnutrition, prolonged total parenteral 
nutrition without thiamine supplementation, and increased nutrient requirements 
as in trauma or septic shock. WE is a well-known postoperative complication of 
gastric restrictive surgery for morbid obesity, after which patients often 
experience protracted nausea and vomiting, leading to malnutrition and massive 
weight loss.
PRESENTATION OF CASE: This case report concerns WE occurring in a patient who 
underwent Roux-en-Y subtotal gastrectomy for gastric cancer, and subsequently 
experienced neurological symptoms that proved irreversible probably due to the 
lengthy time elapsing between their clinical presentation and the diagnosis of 
WE.
DISCUSSION: There have been some reports of WE occurring after total or subtotal 
gastrectomy for gastric cancer in non-obese patients with no history of 
alcoholism, but monitoring for WE has yet to be recommended in the clinical 
guidelines in this setting (as it has for bariatric surgery). Because of its 
rarity and variable clinical presentation, WE is often under-diagnosed and 
under-treated, and confused with other neurological problems.
CONCLUSION: There is an urgent need for the specific guidelines to take into 
account not only the neoplastic follow-up of such patients, but also the 
possible side effects of necessary surgery, since this could help to ensure the 
timely diagnosis and management of WE in this setting, and to avoid, when 
possible, claims for medical malpractice that may cause enormous costs both in 
economical and professional terms.