[Wernicke encephalopathy after subtotal gastrectomy for morbid obesity]. / Encéphalopathie de Gayet-Wernicke après gastrectomie partielle pour obésité morbide.

Wernicke's encephalopathy (WE) is one of the potential complications of obesity surgery. It is an acute neuropsychiatric syndrome resulting from thiamine deficiency often associated with repeated vomiting. The classic triad is frequently reported in these patients (optic neuropathy, ataxia and confusion), associated with uncommon features. Cerebral impairment affects the dorsal medial nucleus of the thalamus and the periaqueductal grey area, appearing on MRI, as hyperintense signals on T2, Flair and Diffusion weighted imaging. Early diagnosis and parenteral thiamine are required to decrease morbidity and mortality. We report a case of WE and Korsakoff's syndrome in a young obese patient after subtotal gastrectomy, who still has substantial sequelae. The contribution of MRI with diffusion-weighted imaging is illustrated. The interest of nutritional supervision in the first weeks and preventive thiamine supplementation in case of repeated vomiting are of particular importance in these risky situations.

[Femoral-venous catheterization: a delayed perforation]. / Cathétérisme veineux fémoral: cas d'une perforation secondaire.

Later vascular injury after central venous catheterization is not common. In literature, there are only cases reporting jugular or subclavian vein catheterization territories with a higher significative risk if the catheter is larger and in left position. We report a case of inferior vena cave perforation, nine days following femoral vein catherization for parenteral nutrition in a 72-year-old patient. This vascular perforation induced an infusion in the peritoneal and the retroperitoneal cavity with abdominal and pelvic pain. This case report may ask the question of recommendations about femoral catherization.