False acute abdomen with lactic acidosis in vitamin B1 deficiency.

We report a case of vitamin B1 deficiency complicated with intestinal paralysis and severe lactic acidosis. A 60-year-old man was admitted to a local hospital complaining of severe abdominal pain. His pain worsened despite administration of pentazocine and his consciousness level deteriorated, so he was transferred to our hospital. His abdomen was markedly distended, and X-ray showed small intestine dilatation. Arterial blood gas showed marked metabolic acidosis. These clinical findings were highly suggestive of acute abdomen, probably superior mesenteric artery thrombosis, or strangulated viscus. However, findings of exploratory laparotomy were unremarkable except for intestinal dilatation. He had alcoholic liver cirrhosis and was chronically malnourished. His chest X-ray and hemodynamic data showed high output heart failure, and were compatible with shoshin beriberi. We suspected that his clinical symptoms were caused by vitamin B1 deficit, so high dose thiamine hydrochloride was intravenously administrated. Metabolic acidosis and hemodynamics were rapidly normalized, followed by improvement of bowel movement. Blood vitamin B1 taken before administration of thiamine hydrochloride showed a low value. It has been described that beriberi can be complicated with constipation, but there has been no report of a case resembling acute abdomen. Our experience with this patient suggests that vitamin B1 deficit may cause intestinal paralysis and resemble acute abdomen.