Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2021; 9(8): 1909-1915
Published online Mar 16, 2021. doi: 10.12998/wjcc.v9.i8.1909
Bilateral common peroneal neuropathy due to rapid and marked weight loss after biliary surgery: A case report
Min Woo Oh, Min Su Gu, Hyun Ho Kong
Min Woo Oh, Min Su Gu, Hyun Ho Kong, Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju 28644, South Korea
Author contributions: Oh MW was the patient’s doctor, reviewed the literature and drafted manuscript; Gu MS collected medical history and diagnostic findings; Kong HH designed this report and supervised study; all authors have read and approve the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and received according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hyun Ho Kong, MD, Doctor, Professor, Department of Rehabilitation Medicine, Chungbuk National University Hospital, 776, 1 Sunhwan-ro, Seowon-gu, Cheongju 28644, South Korea. doctorkonghh@cbnuh.or.kr
Received: October 12, 2020
Peer-review started: October 12, 2020
First decision: January 7, 2021
Revised: January 12, 2021
Accepted: January 25, 2021
Article in press: January 25, 2021
Published online: March 16, 2021
Abstract
BACKGROUND

The causes of peroneal neuropathy are various, but are rarely due to weight loss. Bilateral peroneal neuropathy caused by weight loss after surgery has been reported only after bariatric surgery and there were no reports associated with other abdominal surgery. In this report, we describe a case of the bilateral peroneal neuropathy that occurred due to marked weight loss after biliary surgery.

CASE SUMMARY

A 58-year-old male did not receive adequate nutritional support after biliary surgery, and showed a massive weight loss over a short period of time (body mass index; 24.1 kg/m2 to 20.5 kg/m2 for 24 d). Then, foot drop occurred on both sides. Physical examination, electromyography (EMG) and magnetic resonance imaging studies were conducted and he was diagnosed as bilateral common peroneal neuropathy around the fibular head level. The patient was treated electrical stimulation therapy on both lower legs along with exercise therapy, and received sufficient oral nutritional support. The patient gradually recovered to his original weight, and the power of the dorsiflexor of bilateral ankles improved after conservative treatment. In addition, the follow-up EMG showed signs of improvement.

CONCLUSION

Any abdominal surgery that may have rapid and marked weight loss can lead to peroneal neuropathy as a complication.

Keywords: Peroneal neuropathies, Weight loss, Nutritional status, General surgery, Complication, Case report

Core Tip: Slimmer's paralysis is peroneal neuropathy caused by excessive weight loss such as bariatric surgery, anorexia nervosa or intentional diet, and most of them are unilateral neuropathy. Although it may appear as bilateral paralysis infrequently, there have been no reports that bilateral peroneal neuropathy occurred after abdominal surgery other than bariatric surgery. As shown in this case report, bilateral slimmer's paralysis may occur in any abdominal surgery where excessive weight loss is expected if sufficient nutritional support after surgery is not provided. Therefore, more attention should be paid to the nutritional management of the patient after any abdominal surgery.