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Answer:
Vitamin B12 deficiency.
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Evidence: from
Hx fatigue, peripheral neuropathy of long duration (B12 deficiency to develop need long time) , Hx of multiple bowel surgeries (ileal resection, ileum is the site of vit B12 absorption).
From
Investigation : macrocytic Anemia, build up of MMA : B12 is a Coenzyme needed to convert MMA to succinyl CoA.
Further reading :
https://www.researchgate.net/figure/B-12-dependent-enzymic-reactions_fig3_269469564
