Case Report
Copyright ©2013 Baishideng. All rights reserved.
World J Clin Cases. Apr 16, 2013; 1(1): 52-55
Published online Apr 16, 2013. doi: 10.12998/wjcc.v1.i1.52
Liver failure in an obese middle-aged woman after biliointestinal bypass
Dolores Sgambato, Gaetano Cotticelli, Ilario de Sio, Annalisa Funaro, Anna Del Prete, Chiara de Sio, Lorenzo Romano, Alessandro Federico, Antonietta Gravina, Agnese Miranda, Carmelina Loguercio, Marco Romano
Dolores Sgambato, Gaetano Cotticelli, Ilario de Sio, Annalisa Funaro, Anna Del Prete, Chiara de Sio, Lorenzo Romano, Alessandro Federico, Antonietta Gravina, Agnese Miranda, Carmelina Loguercio, Marco Romano, Department of Clinical and Experimental Medicine “Magrassi-Lanzara”, Gastroenterology Unit, Second University of Naples, 80131 Naples, Italy
Author contributions: Cotticelli G and de Sio I made substantial contributions to the conception and design of the study; Funaro A, Sgambato D, Del Prete A, de Sio C and Romano L were involved in the acquisition, analysis and interpretation of data; Federico A, Gravina A and Miranda A were involved in drafting the manuscript and critically revising it for important intellectual content; Loguercio C and Romano M approved the final version for publication.
Correspondence to: Marco Romano, MD, Department of Clinical and Experimental Medicine “Magrassi-Lanzara”, Gastroenterology Unit, Second University of Naples, Via Pansini 5, 80131 Naples, Italy. marco.romano@unina2.it
Telephone: +39-81-5666718 Fax: +39-81-5666736
Received: January 11, 2013
Revised: March 26, 2013
Accepted: March 28, 2013
Published online: April 16, 2013
Abstract

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.

Keywords: Bariatric surgery, Biliointestinal bypass, Liver failure, Non-alcoholic fatty liver disease, Obesity, Rapid weight loss

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.