Hepatic encephalopathy after sleeve gastrectomy: a hypothesis of its development

Abstract

A 65-year-old male (body mass index 56 kg/m2; weight 144 kg; height 161 cm) with a history of chronic alcohol consumption underwent bariatric surgery. During sleeve gastrectomy, a cirrhotic-looking liver was found, but biopsy was not performed. Six months later, the patient lost 60 kg and began to experience progressive cognitive deterioration with periods of greater lucidity and others of agitation and disorientation. At that time, abdominal examination was normal and neurologic examination showed important cognitive impairment and incomprehensible speech with Glasgow score of 12 with no neurologic focality.