Wernicke's encephalopathy (WE) secondary to hyperemesis gravidarum (HG) is a rare but a known complication. A delay in diagnosis and treatment often results in long-term neurological sequelae. Critical care management of these patients is reported in the literature, but their anesthetic management for cesarean section is lacking. We report the case of a 28-year-old parturient who presented with HG in the first trimester of pregnancy and was managed conservatively. She later developed nystagmus, weakness, and cognitive dysfunction, and a diagnosis of WE secondary to HG was established. The patient was later posted for cesarean section in view of persistent quadriparesis and cognitive impairment at term gestation. General anesthesia was the preferred anesthesia technique of choice. Obstetric patients with preexisting neurological disease for cesarean section become a special subpopulation for anesthesiologists with their unique anesthetic challenges.

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The provision of early and adequate nutritional support is vital for the successful recovery from the trauma in any form. Nutritional support is enteral unless specified otherwise as dictated by various benefits of the former. Nasogastric tubes provide effective and common mode of enteral feed due to the ease of placement and maintenance. To our knowledge, the late presentation of diaphragmatic hernia with gastric perforation in a trauma patient leading to feed coming through chest tube is very rare of the complications.