Iatrogenic kwashiorkor after distal gastric bypass surgery: the consequences of receiving multinational treatment

Abstract

Protein-calorie malnutrition or kwashiorkor is extremely rare after gastric bypass surgery. We report a case of a woman referred to a weight management clinic in the United Kingdom who developed bilateral leg oedema 2 years after gastric bypass surgery in Tunisia. Her serum albumin concentration was 24 g/l, and her body mass index was 16.2 kg/m(2). A review of the postoperative report of her bariatric surgery revealed that she had undergone a distal bypass with anastomosis of the intestine at 1 m proximal to the ileocaecal valve. She required gastrostomy feeding for 6 months before undergoing revisional surgery to a proximal Roux-en-Y gastric bypass in order to restore healthy weight. We recommend that if patients are having their bariatric surgery outside of their country of residence, they should always obtain a copy of the operative notes so that these are readily available if complications arise.

Difference between kwashiorkor and marasmus: Comparative meta-analysis of pathogenic characteristics and implications for treatment

“…As a consequence, some restrictive diets are leading increasingly iatrogenic nutritional issues. Indeed, both marasmus and kwashiorkor have been mentioned in several reports as the results of medical mismanagement leading to negligent adverse events (45,46). These reports emphasized the potential danger of inappropriate restrictive diets in infants and stressed the need for careful nutritional guidance in the management of nutritional diseases (42).…”

Revisional surgery in severe nutritional complications after bariatric surgical procedures: report of four cases from a single institution and review of the literature

“…With regard to the clinical presentation, patients with severe malnutrition requiring revisional operations, usually have hypoalbuminemia, anemia, renal failure, liver failure, ascites, anasarca, and they require preoperative parenteral nutrition 8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] .…”

“…Revision procedures (elongation of the common channel) and conversion techniques are mostly associated with malabsorption, such as BPD, BPD with duodenal switch, and distal gastric bypass, into conventional gastric bypass are widely used techniques and they also maintain a metabolic component to prevent obesity relapse. Reversals are obviously chosen in patients with severe malnutrition or those who underwent revisional surgery 8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] .…”