Micro-nutrient deficiency in a case of jejunoileal bypass.

Abstract

This report describes various clinical and micro-nutrient abnormalities that existed in a 47-year-old woman who underwent a jejunoileal bypass operation. She exhibited extensive electrolyte, mineral, amino acid, and vitamin deficiencies. Amino acid absorption tests indicated an inability to absorb essential amino acids, especially the branched-chain and aromatic varieties. Vitamin absorption tests indicated an inability to notably absorb folic acid, niacin, vitamins B6, A, and E; the fat-soluble beta-carotene (provitamin A) was not absorbed from the diet. A liver biopsy revealed that 80% of the tissue was filled with fatty cysts. The ensuing liver disease compounded with biochemical abnormalities due to the bypass, contributed to the patient's death.

Dieting dilemmas: the very low calorie diet and surgical treatment programs.

“…Because of late nutrient deficiencies developing after bypass surgery (such as that of magnesium, described by Dyckner et al [16], and that of amino acids and vitamins, as well as electrolytes, described by ten Hove and Baker [17], in the last issue of this journal), authorities have recommended that the jejuno-ileal bypass be restricted to selected patients with morbid obesity [18][19][20]. The more recently employed gastric plication operations are not associated with severe nutrient deficiency states; however, there are limited data on patients ten years after the initial operation [21,22].…”