Ewha Med J EMJ The Ewha Medical Journal 2234-3180 2234-2591 Ewha Womans University School of Medicine 10.12771/emj.2015.38.1.42 Case Report Night Blindness Induced by Long-term External Bile Drainage Lee Seung Min Choi Jin Young Kang Ho Jun Sung Ji Hee Park Sang Jong Yoo Sun Hong Park Young Min Department of Internal Medicine, Bundang Jesaeng Hospital, Seongnam, Korea. Corresponding author: Sang Jong Park. Department of Internal Medicine, Bundang Jesaeng Hospital, 20 Seohyeon-ro, 180 beon-gil, Bundang-gu, Seongnam 463-774, Korea. Tel: 82-31-779-0207, Fax: 82-31-779-0929, elwind@daum.net 03 2015 26 03 2015 38 1 42 45 25 07 2014 08 10 2014 Copyright © 2015, The Ewha Medical Journal 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Vitamin A deficiency can occur as a result of malnutrition, malabsorption, or poor vitamin metabolism due to liver disease and night blindness might develop as the first symptom. Although there have been foreign reports about night blindness due to vitamin A deficiency which was derived from liver cirrhosis, primary biliary cirrhosis, intestinal bypass surgery or bariatric operation, it is hard to find reports about night blindness after percutaneous transhepatic biliary drainage for external bile drainage. We report a case of night blindness derived from fat-soluble vitamin A deficiency developed after long-term (18 months) external bile drainage for benign biliary stricture occurred after left hepatic lobectomy and hepaticojejunostomy due to the Klatskin tumor (IIIb). Her night blindness and low serum retinol level (0.02 mg/L) was dramatically improved after vitamin A supplementation. We recommend lipid-soluble vitamin supplementation on the case of long-term external bile drainage.

 Vitamin A deficiency Night blindness Percutaneous transhepatic biliary drainage Braunstein A Trief D Wang NK Chang S Tsang SH Vitamin A deficiency in New York City Lancet 2010 376 267 Chae T Foroozan R Vitamin A deficiency in patients with a remote history of intestinal surgery Br J Ophthalmol 2006 90 955 956 Slater GH Ren CJ Siegel N Williams T Barr D Wolfe B Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery J Gastrointest Surg 2004 8 48 55 Goodman DS Vitamin A and retinoids in health and disease N Engl J Med 1984 310 1023 1031 Mahmood K Samo AH Jairamani KL Ali G Talib A Qazmi W Serum retinol binding protein as an indicator of vitamin A status in cirrhotic patients with night blindness Saudi J Gastroenterol 2008 14 7 11 Waqar S Kersey T Byles D Night blindness in primary biliary cirrhosis CMAJ 2010 182 1212 Phillips JR Angulo P Petterson T Lindor KD Fat-soluble vitamin levels in patients with primary biliary cirrhosis Am J Gastroenterol 2001 96 2745 2750 Walt RP Kemp CM Lyness L Bird AC Sherlock S Vitamin A treatment for night blindness in primary biliary cirrhosis Br Med J (Clin Res Ed) 1984 288 1030 1031 Yoon DH Lee SW Choi U Opthalmology 7th ed Seoul Ilchokak 2006 Smith J Steinemann TL Vitamin A deficiency and the eye Int Ophthalmol Clin 2000 40 83 91 Magnetic resonance cholangiopancreatography 3 years after the operation. Severe stenosis is noticed at hepaticojejunostomy site (arrow). Percutaneous transhepatic biliary drainage is placed at the bile duct of posterior inferior segment (B6). Magnetic resonance cholangiopancreatograph (MRCP) 4 years after the operation. There is no change compared with the previous MRCP.