ArticleMedicine2026
Lifelong vitamin B12 monitoring after gastrectomy: A case report of subacute combined degeneration with 8-year latency in an alcoholic.
Article in Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
rationaleAlthough vitamin B12 deficiency is a well-known complication following total gastrectomy, subacute combined degeneration (SCD) rarely develops beyond 5 years postoperatively. Eight-year latency cases are rarely reported, especially when combined with chronic alcohol use, which accelerates neurologic decline and worsens prognosis. This report aims to present a rare case of delayed SCD after total gastrectomy in a patient with chronic alcoholism, emphasizing the importance of lifelong vitamin B12 monitoring in high-risk individuals. PATIENT CONCERNS: A 49-year-old man presented with progressive quadriparesis and sensory disturbances eight years after total gastrectomy for gastric cancer. He also had a significant history of chronic alcohol consumption, raising suspicion for multifactorial vitamin B12 deficiency. DIAGNOSES: Laboratory tests revealed severe vitamin B12 deficiency, pancytopenia, and elevated homocysteine and methylmalonic acid levels. Cervical spine magnetic resonance imaging revealed T2-weighted hyperintensity in the dorsal columns, consistent with SCD.
interventionsThe patient received vitamin B12 supplementation and underwent a comprehensive rehabilitation program aimed at improving motor function. OUTCOMES: After rehabilitation, he regained independent ambulation using a cane. LESSONS: This case shows an unusually prolonged latency of SCD after total gastrectomy and is notable for the coexistence of 2 established risk factors: gastrectomy and chronic alcoholism. It emphasizes the importance of lifelong surveillance of vitamin B12 status to prevent avoidable and potentially irreversible neurologic complications in high-risk populations.
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