Published online Apr 16, 2013. doi: 10.12998/wjcc.v1.i1.52
Revised: March 26, 2013
Accepted: March 28, 2013
Published online: April 16, 2013
Obesity is considered an emerging epidemic that is often associated with non-alcoholic fatty liver disease. Among the therapeutic options for morbid obesity, bariatric surgery plays an important role when conventional therapies fail. The effects of bariatric surgery on liver function and morphology are controversial in the literature. Liver failure has been reported after jejunoileal bypass (JIB), biliopancreatic diversion and gastric bypass. Biliointestinal bypass (BIB) is considered an effective procedure among recently introduced bariatric surgery techniques. It is a clinically safe, purely malabsorptive operation in which the blind intestinal loop of the JIB is anastomosed to the gallbladder, allowing a portion of bile to transit into excluded intestinal tract. BIB is the only procedure, to our knowledge, to have no liver side effects reported in the literature. We report the case of a young obese woman who developed liver failure 8 mo after BIB. She had a rapid weight loss (70 kg) with a reduction in body mass index of 41% from January to September 2012. Because of a severe hepatic decompensation, she was referred to a transplantation centre. We strongly believe that the most important pathogenetic mechanism involved in the development of liver injury is the rapid weight loss that produced a significant fatty liver infiltration.
Core tip: Biliointestinal bypass (BIB) is considered an effective procedure among recently introduced bariatric surgery techniques. Liver failure has been described after jejunoileal bypass, biliopancreatic diversion and gastric bypass; however, no case of liver injury has been reported after BIB in the literature, to our knowledge. We present a case of liver failure that developed 8 mo after biliointestinal derivation in a young obese patient, who subsequently required a liver transplantation.