Lee Hwajeong, Carlin Arthur M, Ormsby Adrian H, Lee Min W
Department of Pathology and Laboratory Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
Obes Surg. 2009 Aug;19(8):1176-9. doi: 10.1007/s11695-009-9872-0. Epub 2009 Jun 9.
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.
一名58岁女性，1980年因减肥接受空肠回肠旁路手术，现因多种不适前来就医。自26年前接受旁路手术以来，该患者未服用任何营养补充剂。她被诊断患有骨软化症、慢性腹泻、继发性甲状旁腺功能亢进和高草酸尿症，并有频繁的肾结石病史。由于她严重的骨营养不良和代谢并发症，建议逆转其空肠回肠旁路手术。遂进行了空肠回肠旁路逆转术并加做袖状胃切除术。剖腹手术显示整个消化道肢体呈褐色变色，旁路肠段萎缩。切除的小肠组织学检查显示肠壁平滑肌细胞内有褐色色素沉着。该色素经Fontana-Masson染色呈阳性，很可能代表脂褐素。我们报告一例空肠回肠旁路术后并发褐色肠综合征的病例，据我们所知，这是文献中报道的首例。
