Rhabdomyolysis after Biliopancreatic Diversion with Duodenal Switch

Abstract

Rhabdomyolysis is an uncommon event in bariatric surgery. It can be caused by ischemia, crush injury, alcohol ingestion and drug intake, and as a consequence renal failure can develop. A few reports indicate that patients undergoing bariatric surgical intervention are at risk for rhabdomyolysis. A super-obese male (BMI 52 kg/m2) is reported, who underwent laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS). Operative time was 265 minutes, and the BPD/DS operation was uneventful. Post-operatively, the patient complained of pain in both hips and the left shoulder, and suffered oliguria. He was treated with fluids (isotonic saline), bicarbonate, and mannitol. Despite this, he developed renal failure, which subsequently required hemodialysis. The patient died from arrhythmia and cardiac arrest on the 8th postoperative day. Obese patients undergoing bariatric surgery are at risk of rhabdomyolysis. Prolonged compression of the muscles during the surgical intervention, in long laparoscopic procedures, predisposes to this complication.

Rhabdomyolysis After Bariatric Surgery by Roux-en-Y Gastric Bypass: A Prospective Study

“…Sixty-three percent of our patients were female, similar to many available cases reports [19,20,[23][24][25] and prospective studies [29,30,31]. The preponderance of females is probably a result of a higher prevalence of obesity and MO in this gender.…”

“…Although RML in BS has been described as a rare complication in case reports [11,[18][19][20][21][22][23][24][25][26][27][28]37] (Table 3), it was diagnosed in 77.3% (17) of our patients, indicating it is a common problem in the postoperative period of this surgical procedure. Similar high frequencies were also found in three other available prospective studies [29,30,31] (Table 4).…”

“…In our series, gender was not a risk factor of occurrence of RML. However, in the prospective study of Carvalho et al [30] and many case reports [11,[19][20][21][22][23][24][25][26][27][28], RML has been more commonly seen in men. A possible explanation for this finding is obesity being more severe in men.…”

“…According to the extension damage, it can be asymptomatic or lifethreatening due to the possibility of hypovolemia, electrolytic disturbs, coagulopathy, and renal failure. RML in BS has been previously described mainly as case reports [11,[18][19][20][21][22][23][24][25][26][27][28] with just a few longitudinal studies about its frequency [29][30][31].…”

A Nationwide Survey on Bariatric Surgery in Germany—Results 2005–2007

“…In the present study, the mortality associated with rhabdomyolysis was 0.06%. Worldwide, 33 fatal outcomes after rhabdomyolysis following bariatric surgery have been reported [20][21][22]. Because this study was based on voluntary participation, it is highly likely that the actual mortality might be higher than that reported herein.…”