Bowel-Associated Dermatosis-Arthritis Syndrome after Biliopancreatic Diversion

Abstract

The bowel-associated dermatosis-arthritis syndrome (BADAS), originally called the bowel bypass syndrome, and described after jejuno-ileal bypass, has subsequently been reported in association with inflammatory bowel disease and after gastric resection. BADAS has not been reported after biliopancreatic diversion (BPD). This case report describes a 47-year-old female who presented with recurrent skin rashes and arthralgia after a BPD, consistent with a clinical diagnosis of BADAS which was confirmed by skin biopsy. To date, she has been managed with cyclical courses of antibiotics without reversal of her surgery. This syndrome may be under-diagnosed and is a condition with which bariatric surgeons should be familiar.

Bowel bypass syndrome/bowel-associated dermatosis arthritis syndrome post laparoscopic gastric bypass surgery

“…10 Other procedures such as Bilroth II surgery and biliopancreatic diversion have also been associated with BBS. 2,11 Generally, the clinical lesions associated with BADAS resemble pyoderma gangrenosum. The significance of clinical features is further highlighted in a recent case demonstrating atypical histopathology in the presence of classical clinical symptoms and signs.…”

Leg pain and rash in a man with prior bariatric surgery

“…Classically, BADAS has been associated with patients who have undergone bariatric and other bowel‐related surgeries. It has been described after Billroth II gastrectomy, jejuno–ileal bypass, biliopancreatic diversion and gastric resection, and also after laparoscopic bariatric procedures . Furthermore, BADAS has been reported in patients who have not undergone any bowel procedures but rather have had other gastrointestinal (GI) issues such as appendicitis, inflammatory colitis, and diverticulosis .…”

“…Furthermore, BADAS has been reported in patients who have not undergone any bowel procedures but rather have had other gastrointestinal (GI) issues such as appendicitis, inflammatory colitis, and diverticulosis . The histopathology of BADAS is described as similar to that of the neutrophilic dermatoses, such as Sweet's syndrome . However, unlike classic Sweet's syndrome, some reports of BADAS have described a vasculitic component .…”

Spondyloarthropathy After Ampullary Carcinoma Resection

“…4,8,10 With rare exception, reanastomosis to reestablish bowel continuity has eliminated the syndrome. 9,10, [15][16][17] Although originally described after jejuno-iliac bypass, BADAS occurs more commonly after a jejuno-colic anastomosis 18 and has also been described in association with bilio-pancreatic diversion or bilio-intestinal bypass for morbid obesity, 19,20 Crohn disease, ileoanal pouch anastomosis, 21,22 ulcerative colitis, appendicitis, 23 diverticulitis, 11 and after Billroth II gastrectomy. 16,24 The standard surgical approach to carcinoma of the ampulla of Vater is the Whipple procedure, which involves en bloc resection of the gastric antrum and duodenum, a segment of the first portion of the jejunum, gallbladder, and distal common bile duct, the head and often the neck of the pancreas, and adjacent regional lymph nodes.…”