We report herein the case of a 56-year-old woman who developed secondary
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-
gastrectomy. 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. In an attempt to permanently resolve the ongoing
Kwashiorkor symptoms, reconstructive surgery involving transposition of the jejunum from the previous Graham method to the interposition method was performed 10 years after the initial
gastrectomy. After the second operation, her
malnutrition 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 alleviated by altering the procedure of reconstruction of the intestinal tract. Thus, we recommend surgical treatment to alter the digestive continuity to a more physiological pathway for selected patients with secondary
Kwashiorkor syndrome.