Rapid development of micronodular cirrhosis following small bowel by-pass for obesity. A form of iatrogenic nutritional cirrhosis?

Two cases of rapidly progressive fatal liver disease in females after by-pass surgery for obesity are reported. Histologically the livers are similar to the florid cirrhosis of the alcoholic described by Popper and Szanto. It is postulated that the nutritional disturbance, including protein deficiency, and large amounts of fatty acids delivered to the liver from the fat depots, results in fatty metamorphosis, the Mallory bodies and finally cirrhosis. Bacterial toxins from the excluded loop of intestine may contribute to this process.