Massive Lower Gastrointestinal Bleeding in Association with the Brown Bowel Syndrome

Brown Bowel Syndrome in a Middle-Aged Woman with Chronic Idiopathic Malabsorption

Brown bowel syndrome (BBS) is an extremely unusual condition characterized by an orange-brown discoloration of the bowel and intestinal motility disorders secondary to fat-soluble vitamin deficiency and malabsorption from many different causes. We present the case of a middle-aged woman suffering for years of chronic constipation with recurrent intestinal subocclusion, who was diagnosed BBS on surgical biopsy material. Nutritional supplementary treatment was tried, but her symptoms did not improve, and a decision was finally made in favor of a surgical approach. After subtotal colectomy and continual vitamin nutritional supplementation, she has now regular transit without the use of laxatives. BBS is a rare complication of long-term malabsorption manifesting as intestinal motility disorders, which can lead to severe complications. This condition is only partially responsive to vitamin supplementation, and most cases require surgery.

Brown bowel syndrome secondary to jejunoileal bypass: the first case report

A 58-year-old woman with a surgical history of jejunoileal bypass in 1980 for weight reduction sought medical attention with multiple complaints. The patient had not been taking any nutritional supplements since her bypass surgery, 26 years previously. She was found to have osteomalacia, chronic diarrhea, secondary hyperparathyroidism, and hyperoxaluria with a frequent history of nephrolithiasis. Because of her severe osteodystrophy and metabolic complications, reversal of her jejunoileal bypass was recommended. Reversal of the jejunoileal bypass with a sleeve gastrectomy was performed. Laparotomy revealed brown discoloration of the entire alimentary limb with atrophy of the bypassed intestinal limb. Histologic examination of the resected small bowel demonstrated brown pigment deposits within smooth muscle cells of the bowel wall. The pigment stained positive with Fontana-Masson most likely representing lipofuscin. We report a case of brown bowel syndrome complicating jejunoileal bypass, the first case reported in the literature to the best of our knowledge.

Brown bowel syndrome occurring in coeliac disease in the west of Ireland

Brown bowel syndrome is the name applied to a brown discoloration of the intestine. This is due to lipofuscin deposition in intestinal smooth muscle and occurs in association with malabsorption. Three cases occurring in a coeliac registry of 559 patients are described. One patient presented with acute massive bleeding per rectum, and two were diagnosed at autopsy. The syndrome may be accompanied by vitamin E deficiency and neurologic dysfunction. Two patients had evidence of peripheral neuropathy, and one had low vitamin E levels. Concomitant vitamin D deficiency was present. Fat-soluble vitamin malabsorption, especially if there is a poor response to a gluten-free diet or neuropathy, might alert the clinician to the possibility of brown-bowel syndrome and suggests careful search for lipofuscin in biopsy material, using special histologic techniques.