Takotsubo Syndrome as a Cause of False Acute Abdomen in the Early Postoperative Period After Bariatric Surgery–a Report of Two Cases

Viegas, Fábio; Viegas, Carla; França, Enio; Kleuser, Klaus; Barros, Fernando de

doi:10.1007/s11695-016-2326-6

Cited by 5 publications

(5 citation statements)

References 8 publications

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“…Tori et al reported TC developing after cholecystectomy for gallstones and common bile stones ( 12 , 16 , 17 ). Viegas et al reported two cases of TC in the “early” postoperative period after bariatric surgery ( 15 ). We believe that thiamine deficient for being noncompliant with long-term postoperative care may have contributed to her cardiac condition, which entertains the possibility of patients having wet beriberi.…”

Section: Discussionmentioning

confidence: 99%

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Acute Cholecystitis in a Gastric Bypass Patient Complicated by Takotsubo Cardiomyopathy

Jawaid¹,

El-Sherif²,

George³

et al. 2022

Case Reports in Surgery

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Background. Gallbladder disease is a common condition after gastric bypass surgery. Even after weight loss, many bariatric patients continue to suffer from comorbid conditions. Takotsubo cardiomyopathy is a rare condition that mimics acute cardiac ischemia but seems to be caused by a catecholamine storm triggered by intense stress. Case Report. A 62-year-old female presented with acute right upper quadrant (RUQ) pain to the ER. She had a history of laparoscopic gastric bypass 5 years ago and had been noncompliant for 2 years. This noncompliance included missing follow-up appointments, gaining weight which caused poorly controlled DM, and not taking her vitamin supplements. Upon presentation, her WBC was elevated, her LFTs were normal, and imaging showed acute calculous cholecystitis. She was admitted and started on antibiotics with plans for laparoscopic cholecystectomy. The next day, she developed acute chest pain, and troponins were elevated with ST changes on EKG. Echocardiography showed a ballooned left ventricle indicative for Takotsubo cardiomyopathy. Symptomatic treatment including antibiotics, betablocker, and thiamine infusion was initiated. At three-month follow-up, ejection fraction had improved from <20% to >50%. The patient underwent interval laparoscopic cholecystectomy, which was technically very challenging due to severe ongoing acute and chronic cholecystitis. There were no cardiac issues, but the patient developed an abscess in the gallbladder fossa, which was successfully treated with oral antibiotics. Conclusions. Takotsubo cardiomyopathy complicating acute cholecystitis has thus far not been reported. Our patient had a history of gastric bypass and was noncompliant with vitamin supplementation. Thiamine deficiency may have contributed to the cardiac condition (wet beriberi).

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Section: Discussionmentioning

confidence: 99%

“…Also, biliary pancreatitis has been complicated by TC, and TC may develop following laparoscopic cholecystectomy ( 13 , 14 ). The development of TC is also documented following gastric bypass surgery ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

Acute Cholecystitis in a Gastric Bypass Patient Complicated by Takotsubo Cardiomyopathy

Jawaid¹,

El-Sherif²,

George³

et al. 2022

Case Reports in Surgery

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“…What also remains unknown is the significance of nutrition disorders in the aetiology and the course of stress cardiomyopathy. Takotsubo syndrome is diagnosed not only in people with low body mass, as there are known cases of people suffering from anorexia, but also in obese patients [18][19][20]. On average, obese patients with TS constitute between 10-20% of the whole group [21,22].…”

Section: Discussionmentioning

confidence: 99%

Takotsubo syndrome – fatal prognosis of patients with low body mass index in 5-year follow-up

Zalewska-Adamiec¹,

Małyszko²,

Bachórzewska−Gajewska³

et al. 2020

aoms

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Introduction: The clinical courses of takotsubo syndrome (TS) and of acute coronary syndromes (ACS) seem to be very similar. However, there is limited knowledge about risk factors of poor outcomes. Low body mass index worsens the prognosis of patients with cardiovascular diseases, especially those undergoing surgical treatment. The aim of the study was to evaluate the influence of the body mass index (BMI) on the prognosis in patients diagnosed with TS. Material and methods: Eighty patients aged 15-89 (mean: 67.9 years), 74 women and 6 men with TS diagnosis according to Mayo Clinic diagnostic criteria were divided into 3 groups: low body mass (BMI < 18.5 kg/m 2), normal body mass (18.5 ≥ BMI < 25 kg/m 2) and excessive body mass (BMI ≥ 25 kg/m 2). Results: Patients with low BMI were older, but with less prevalent risk factors such as hypertension, hypercholesterolemia and positive family history of coronary artery disease and more frequent risk factors such as cigarette smoking, chronic obstructive pulmonary disease (COPD), depressive and anxiety disorders as well as malignancy. They also had higher haemoglobin, lower troponin, creatine kinase, C-reactive protein and lipid fractions. The highest annual, 3-year and 5-year mortality was observed in the group with BMI < 18.5 kg/m 2. None of the patients with low BMI survived the 5-year follow-up period (100% vs. 25% vs. 15.2%; p < 0.0001). In group III, mortality among overweight patients (25 ≥ BMI < 30 kg/m 2) was 8.3%, and in obese people (BMI ≥ 30 kg/m 2) 1 out 5 patients died during follow-up. Conclusions: The majority of typical cardiovascular risk factors are less frequently observed in patients with TS and low body mass. Early prognosis for TS patients and low BMI is relatively favourable, whereas the 5-year follow-up is associated with extremely high mortality. Overweight patients have the best prognosis in the long-term follow-up.

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“…The PubMed was employed from its inception to 9/6/22 in response to MeHS “obesity and takotsubo” and 29 articles were accessed [ 2 , 3 , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] ]; in addition, a recently published article with reference to morbid obesity [ 36 ] was included, for a total of 30 articles. A meta-analysis could not be performed, since many of the accessed articles ( Table 1 ) did not comprise granular (individual patient-based) information on obesity.…”

Section: Methodsmentioning

confidence: 99%

“… 10. [ 18 ] A report of 40-year old woman with HTN and obesity (BMI of 43.28 kg/m 2 ) who suffered TTS 105 days after BS, and following laparoscopic surgery for a subphrenic abscess resulting from the BS, who also received dopamine and NE; also, a report of a 31-year old woman with HTN and obesity (BMI 38.28 kg/m 2 ) who developed TTS in the immediate postoperative period following BS. 11.…”

Section: Methodsmentioning

confidence: 99%

“Obesity paradox” and takotsubo syndrome

Madias¹

2022

International Journal of Cardiology Cardiovascular Risk and Pre

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Takotsubo Syndrome as a Cause of False Acute Abdomen in the Early Postoperative Period After Bariatric Surgery–a Report of Two Cases

Cited by 5 publications

References 8 publications

Acute Cholecystitis in a Gastric Bypass Patient Complicated by Takotsubo Cardiomyopathy

Acute Cholecystitis in a Gastric Bypass Patient Complicated by Takotsubo Cardiomyopathy

Takotsubo syndrome – fatal prognosis of patients with low body mass index in 5-year follow-up

“Obesity paradox” and takotsubo syndrome

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