Zubiaga Toro Lorea, Ruiz-Tovar Jaime, Castro María J, Ortiz de Solórzano Francisco J, Luque de León Enrique, Jiménez José M, Carbajo Miguel Á
Center of Excellence for the Study and Treatment of the Obesity and Diabetes (CTO).
Department of Nutrition and Endocrinology. Universidad de Valladolid.
Nutr Hosp. 2019 Mar 7;36(1):238-241. doi: 10.20960/nh.02258.
Malabsorptive bariatric techniques are associated with nutritional deficiencies. However, when patients do not respond to supplemental intensive treatments they should be closely followed because they can hide other pathological conditions. We present the case of a 47-year-old man with morbid obesity (body mass index [BMI]: 48 kg/m2) who underwent bariatric surgery. In 2016, he presented severe pneumonia and hospitalization at the Intensive Unit Care was required. After this episode, his nutritional state impaired, presenting 6-7 diarrhea/steatorrhea events per-day and requiring several hospitalizations due to the persistence of severe hypoproteinemia. He was given parenteral high-protein associated with low-fat oral diet. He presented a temporary biochemical improvement, but the hypoproteinemia recurred. Finally, tests revealed the presence of Tropheryma whipplei as protein-losing enteropathy. Whipple's disease (WD) is a rare cause of diarrhea and malnutrition, and these symptoms can be confused with the postoperative status of malabsorptive bariatric techniques. WD requires early diagnosis with prolonged antibiotic treatment to avoid severe complications.
吸收不良型减肥手术技术与营养缺乏有关。然而，当患者对强化补充治疗无反应时，应密切随访，因为他们可能掩盖其他病理状况。我们报告一例47岁男性病态肥胖患者（体重指数[BMI]：48kg/m²），其接受了减肥手术。2016年，他出现严重肺炎，需要入住重症监护病房。此次发作后，他的营养状况受损，每天出现6 - 7次腹泻/脂肪泻，且因严重低蛋白血症持续存在而需要多次住院。给予他肠外高蛋白联合低脂口服饮食。他出现了暂时的生化指标改善，但低蛋白血症复发。最终，检测发现存在惠普尔嗜组织细胞菌，提示为蛋白丢失性肠病。惠普尔病（WD）是腹泻和营养不良的罕见病因，这些症状可能与吸收不良型减肥手术技术的术后状态相混淆。WD需要早期诊断并进行长期抗生素治疗以避免严重并发症。
