Case Report
Copyright ©2009 The WJG Press and Baishideng.
World J Gastroenterol. May 14, 2009; 15(18): 2277-2279
Published online May 14, 2009. doi: 10.3748/wjg.15.2277
Table 1 Laboratory investigations
BUN/Creatinine (normal = 8-26/0.9-1.3)34/8.2
Albumin (normal = 3.5-5.0)1.9
Prothrombin time/INR (normal = 11.9-14.3/< 1.0)25.3/2.4
ALT/AST (normal = 15-41/14-63)45/41
Platelet count (normal = 140-400)129
Serum albumin ascites gradient2.3
Hepatitis profile (A, B, C)Negative
Table 2 Complications of jejunoileal bypass
ProblemMechanismManifestations in this patient
Steatohepatitis Possible cirrhosisAmino acid deficiencyAdvanced liver disease with portal hypertension
Renal oxalosisExcess oxalate absorption; Oxalate not bound by calciumMultiple kidney stones and three previous lithotripsy interventions; Progressive kidney disease due to suspected oxalate nephropathy requiring lifelong hemodialysis
Fat soluble vitamin deficiencyMalabsorption; SteatorrheaSerum levels:
Vitamin A = 17 (360-200 mg/L)
Vitamin D ≤ 10 (22-67 pg/mL)
Vitamin E = 3 (5.5-17.0 mg/L)
Vitamin K ≤ 0.03 (0.1-.2 ng/mL)
GallstonesBile acid loss; Mobilization of cholesterolPrevious cholecystectomy for symptomatic cholelithiasis
EnteritisBacterial overgrowth30 years of diarrhea and steatorrhea Pneumatosis intestinalis
ArthritisBacterial toxin; AutoimmuneBilateral knee and shoulder pain
Fatigue syndromeVitamin deficiency; MultifactorialMarked fatigue, bed-ridden status
Bypass encephalopathyPossible deficiency; Possible D-lactic acid deficiencySlurred speech, incoordination and weakness
Bypass dermatitisPossible antigen-antibody complex (enteric bacteria)Cutaneous urticarial rash