A Rare Cause of Severe Protein-Energy Malnutrition following Bariatric Surgery

Eliana De Rosa, Carmela De Caprio, Carlo Moretto, Rosario Bellini, Rossana Daniela Berta, Marco Anselmino, Franco Contaldo and Fabrizio Pasanisi

Department of Clinical Medicine and Surgery, Interuniversity Research Center for Obesity and Eating Disorders, Italy
Bariatric Surgery Unit, Azienda Ospedaliero-Universitaria Pisana, Italy

^*Correspondance to: Eliana De Rosa 

 PDF  Full Text DOI: 10.25107/2474-1647.2232

Abstract

A 42-y-old man with morbid obesity underwent laparoscopic gastric bypass without acute complications but in the following ten months suffered abdominal pain, vomiting, diarrhea and developed severe protein-energy malnutrition. After non-conclusive laboratory tests and imaging, exploratory laparoscopy showed an internal herniation that was corrected. Persisting post-operative leak required several laparotomic revisions. Roux-en-O misconstruction was recognised and rectified, but retrograde peristalsis resolved only after jejuno-ileal rotation of the antiperistaltic limb. Late detection of the causes of severe protein-energy malnutrition following bariatric surgery may be due to non specific postoperative symptoms and difficult imaging interpretation. Though rare, gastric bypass wrong configurations should always be included in the differential diagnosis. Jejunoileal rotation of the segment showing retrograde peristalsis could be a surgical option, alternative to resection, to spare bowel length. Appropriate follow-up plays a key role in the postbariatric nutritional surveillance and early identification and management of the complications.

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Cite the article

De Rosa E, De Caprio C, Moretto C, Bellini R, Berta RD, Anselmino M, et al. A Rare Cause of Severe Protein-Energy Malnutrition following Bariatric Surgery. Clin Surg. 2018; 3: 2232.