Mizón Claudio, Ruz Manuel, Csendes Attila, Carrasco Fernando, Rebolledo Annabella, Codoceo Juana, Inostroza Jorge, Papapietro Karin, Pizarro Fernando, Olivares Manuel
Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile.
Nutrition. 2007 Mar;23(3):277-80. doi: 10.1016/j.nut.2007.01.008.
We report the case of a 42-y-old morbidly obese woman who presented persistent anemia as result of Roux-en-Y gastric bypass.
The surgical procedure conducted in 1999 consisted of horizontal gastroplasty with truncular vagotomy, Roux-en-Y gastrojejunal anastomosis with an alimentary limb of 60 cm, and cholecystectomy. In 2000 a second surgery (subtotal gastrectomy, i.e., 90%, with a 50-mL gastric pouch) was performed because of failed gastroplasty. Anemia was detected approximately 1 y after the second surgery. This condition worsened significantly after an abdominal lipectomy performed in 2001. Since then, different oral iron compounds were used for treatment, but with unsatisfactory results. The subject was anemic for 4 y.
The condition was corrected only after intravenous iron administration. Iron absorptions from 3 mg of iron as ferrous ascorbate and from a standardized diet that also contained 3 mg of iron were 48.4% and 39.9%, respectively.
Iron absorption tests provided evidence that the reduction of intestinal iron absorption capacity was the most probable cause of the persistent anemia.
我们报告一例42岁病态肥胖女性因Roux-en-Y胃旁路手术导致持续性贫血的病例。
1999年实施的手术包括水平胃成形术加迷走神经干切断术、60厘米长的Roux-en-Y胃空肠吻合术以及胆囊切除术。2000年，由于胃成形术失败进行了第二次手术（胃大部切除术，即90%，保留50毫升胃囊）。第二次手术后约1年发现贫血。2001年腹部脂肪切除术后，这种情况显著恶化。从那时起，使用了不同的口服铁剂进行治疗，但效果不理想。该患者贫血长达4年。
仅在静脉注射铁剂后病情才得到纠正。3毫克抗坏血酸亚铁形式的铁以及同样含有3毫克铁的标准化饮食中的铁吸收分别为48.4%和39.9%。
铁吸收试验提供了证据，表明肠道铁吸收能力降低是持续性贫血最可能的原因。
