Jejunoileal bypass: A surgery of the past and a review of its complications

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 gradient	2.3
Hepatitis profile (A, B, C)	Negative

BUN: Blood urea nitrogen; INR: International normalized ratio; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase.

Table 2 Complications of jejunoileal bypass

Problem	Mechanism	Manifestations in this patient
Steatohepatitis Possible cirrhosis	Amino acid deficiency	Advanced liver disease with portal hypertension
Renal oxalosis	Excess oxalate absorption; Oxalate not bound by calcium	Multiple kidney stones and three previous lithotripsy interventions; Progressive kidney disease due to suspected oxalate nephropathy requiring lifelong hemodialysis
Fat soluble vitamin deficiency	Malabsorption; Steatorrhea	Serum 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)
Gallstones	Bile acid loss; Mobilization of cholesterol	Previous cholecystectomy for symptomatic cholelithiasis
Enteritis	Bacterial overgrowth	30 years of diarrhea and steatorrhea Pneumatosis intestinalis
Arthritis	Bacterial toxin; Autoimmune	Bilateral knee and shoulder pain
Fatigue syndrome	Vitamin deficiency; Multifactorial	Marked fatigue, bed-ridden status
Bypass encephalopathy	Possible deficiency; Possible D-lactic acid deficiency	Slurred speech, incoordination and weakness
Bypass dermatitis	Possible antigen-antibody complex (enteric bacteria)	Cutaneous urticarial rash