Minimally invasive management of complications from jejunoileal bypass

Revisional Bariatric Surgery

Revisional bariatric surgery is a growing subset of all bariatric procedures. Although revisions can be associated with higher morbidity rates and less optimal outcomes than those seen with primary procedures, they can be safely performed, with excellent outcomes and improved quality of life for patients. Facility and familiarity with revisional principles and techniques are necessary components of bariatric surgical practice.

A unique case report of jejunoileal bypass reversal with review of the literature

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 Jejunoileal bypass is a surgery of the past however still affects patients being see by surgeons today.

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The pathophysiology is complicated and it should be known these patients suffer from chronic kidney disease, liver failure, chronic diarrhea and many vitamin deficiencies.

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Bypass reverseal can help preserve kidney function but may not reverse damages already done.

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From our experience, Bypassed bowel incorporation back into enteric tract can produced a immune response causing functional obstruction only relieved by removal of this bowel.

Introduction

Jejunoileal bypass (JIB) was an effective treatment for morbid obesity in the 1970s, but shortly after it fell out of favor due to horrific side effects, including liver failure, nephrolithiasis and drastic vitamin deficiencies. Although there are few living people with JIB, the management of these patients can be challenging.

Case presentation

We describe a case of a 58-year-old female with a history of JIB 46 years prior who had an impending renal failure due to nephrolithiasis. She underwent a jejunostomy feeding tube prior to reversal. After reversal, our patient developed failure to thrive with functional obstruction of the newly incorporated small bowel. This bypassed bowel underwent a severe inflammatory transformation after the introduction of enteric feeds, suggesting an immunological type response to antigens in food. It wasn’t until a long and debilitating 12 months and resection of this inflamed bowel that our patient was able to regain bowel function and gain weight.

Conclusion

Jejunoileal bypass is an archaic procedure for morbid obesity. Due to its debilitating and at times lethal side effects, it has been replaced with newer techniques. Despite advances, there are still patients out there who have had a jejunoileal bypass. This case report and review of the literature details our experience with this procedure.