Intestinal bypass complications involving the excluded small bowel segment.

We have examined complications involving the defunctionalized bowel in 119 intestinal bypass patients. In this group, we found a 66% of incidence of bypass enteropathy. Pneumatosis cystoides intestinalis was present in three patients, severe blood loss in three, localized ulcerations in two, intermittent or chronic intussusception of the proximal jejunal stump in 10, and extensive stenosis relating to tight fibrous adhesions in one patient. The stenosis may become manifest as an obstructive process only after reconstitution of normal bowel continuity. Bacterial overgrowth in the bypassed small bowel was the primary cause for most of the lesions. A consistent diagnostic finding, suggesting disease in the excluded bowel, was ileal distention and the presence of gas-fluid levels on upright abdominal x-rays. Definitive diagnoses of ulceration, intussusception, and/or obstruction were sometimes possible only during laparotomy. Because the bypassed bowel cannot be examined with conventional techniques, these various abnormalities must be suspected when ill-defined abdominal complaints are observed in bypass patients. Metronidazole, to suppress anaerobic organisms, or suitable broad spectrum antibiotics can relieve the various lesions of the inflammatory process, whereas appropriate surgical procedures may be required for some of the chronic or recurrent complications.