Lewandowski Helen, Breen Tracy L, Huang Eric Y
Division of Endocrinology, New York University School of Medicine and Bellevue Hospital Center, New York, New York, USA.
Endocr Pract. 2007 May-Jun;13(3):277-82. doi: 10.4158/EP.13.3.277.
To describe a case of kwashiorkor and an acrodermatitis enteropathica-like eruption associated with zinc deficiency after a distal gastric bypass surgical procedure.
A case report of a morbidly obese patient who underwent a gastric bypass operation is presented, including clinical, laboratory, and radiologic findings. In addition, the literature on potential nutritional deficiencies after bariatric surgical intervention is reviewed.
A 43-year-old woman with a history of morbid obesity underwent a distal Roux-en-Y gastric bypass procedure at an outside institution. Six months later, she presented to our clinic because of abdominal pain, lower extremity edema, and a patchy maculopapular scaling rash. She had not adhered to a vitamin supplementation regimen prescribed postoperatively. Her symptoms progressively worsened, and she was hospitalized for management of severe malnutrition and dehydration. Laboratory tests revealed low levels of albumin, hemoglobin, vitamin A, vitamin D, copper, and zinc and elevated levels of liver enzymes. Anasarca and bowel wall edema were seen on an abdominal computed tomographic scan, and an upper endoscopy revealed a stomal ulcer and a stricture at the site of the gastrojejunal anastomosis. The patient was diagnosed as having kwashiorkor, zinc deficiency, and an acrodermatitis enteropathica-like eruption. Treatment was begun with total parenteral nutrition, which led to alleviation of her symptoms. Approximately 3 months later, she underwent gastric bypass revision but had numerous postoperative complications.
Kwashiorkor and severe nutritional deficiencies were noted in this patient after a distal gastric bypass surgical procedure. This clinical presentation is uncommon and can be attributed to the increased malabsorption that occurs with distal gastric bypass, the development of mechanical complications, and the inadequacy of nutritional supplementation. After a bariatric operation, careful adherence to follow-up regimens and the involvement of a multidisciplinary team can improve the chances of a successful outcome.
描述一例在远端胃旁路手术后出现夸希奥科病及类似肠病性肢端皮炎皮疹伴锌缺乏的病例。
报告一例接受胃旁路手术的病态肥胖患者的病例，包括临床、实验室及影像学检查结果。此外，对减肥手术干预后潜在营养缺乏的相关文献进行综述。
一名有病态肥胖病史的43岁女性在外部机构接受了远端Roux-en-Y胃旁路手术。六个月后，她因腹痛、下肢水肿及斑片状斑丘疹鳞屑性皮疹前来我院就诊。她未遵循术后规定的维生素补充方案。其症状逐渐加重，因严重营养不良和脱水住院治疗。实验室检查显示白蛋白、血红蛋白、维生素A、维生素D、铜和锌水平降低，肝酶水平升高。腹部计算机断层扫描显示全身性水肿和肠壁水肿，上消化道内镜检查显示胃空肠吻合口处有吻合口溃疡和狭窄。该患者被诊断为夸希奥科病、锌缺乏及类似肠病性肢端皮炎皮疹。开始采用全胃肠外营养治疗，症状得以缓解。大约3个月后，她接受了胃旁路修复手术，但术后出现了许多并发症。
该患者在远端胃旁路手术后出现了夸希奥科病和严重营养缺乏。这种临床表现并不常见，可归因于远端胃旁路术后吸收不良增加、机械性并发症的发生以及营养补充不足。减肥手术后，严格遵循随访方案并由多学科团队参与可提高成功治疗的几率。
