![]() The RNYGB procedure consists of the creation of a Roux-en-Y gastrojejunostomy along with a gastric pouch. ![]() Consequently, we suspect post-bariatric surgery liver failure as a culprit. The transplant center asserted it was unlikely that alcoholic cirrhosis contributed to her acute condition. ![]() After a prolonged hospital stay at the transplant center, the patient was transferred back with the etiology of her hepatic failure remaining unknown despite ruling out other chronic liver diseases and acute toxins. A liver biopsy was deferred as well due to her unstable condition. Unfortunately, she was not a candidate for transplant as she was deemed too unstable and suggested to re-evaluate outpatient once the patient is extubated. Her kidney function continued to deteriorate likely due to hepatorenal syndrome and was transferred to a liver transplant center. She then developed acute hypoxic respiratory failure and was placed on mechanical ventilation in the ICU. Furthermore, a recent gastric emptying test performed showed “rapid gastric emptying.” Upon further questioning, her nutrition was further compromised with medication noncompliance of recommended vitamins and minerals due to lack of insurance and was lost to follow up after her RNYGB procedure.ĭuring her hospitalization, her anasarca progressed as her acute on chronic decompensated cirrhosis worsened with her MELD score reaching a peak of 27, INR 2.1 and Cr from 0.5 mg/dl to 2.95 mg/dl within eight days. A prior CT of the abdomen in 2018 showed normal liver. Her post-operative complications involved malabsorption with intractable nausea and vomiting, requiring multiple ED visits. The patient’s family noticed the patient became deconditioned and malnourished two years prior. She endorsed a 48 lbs unintentional weight loss over two months and presented at 60 kg on admission. Her usual body weight was 80 kg (height 158 cm). Her last drink was a month before admission. She was a daily drinker for several years in her early 20s, consuming three to four malt beverages daily, and currently consuming mixed cocktails and malt beer every other day (on average three to four nights per week). The patient has no previous diagnosis of cirrhosis, however, she disclosed a drinking history. Further evaluation with an abdominal ultrasound suggested findings that were consistent with cirrhosis and portal hypertension with no evidence of thrombosis and small volume ascites. Her physical exam was remarkable for conjunctival jaundice and 4+ lower extremity pitting edema up to her lower abdomen.Ī CT of the abdomen and pelvis obtained in the ED showed evidence of portal hypertension and nodular liver with steatosis as well as patchy airspace opacities throughout bilateral lungs that were concerning for atypical viral pneumonia. Her blood work was significant for leukocytosis of 30,000 cmm with a left shift, hemoglobin 8.7 g/dl (was 14 g/dl in 2006), INR 1.5, sodium 129 mmol/L, bicarbonate 18 mEq/L, and pH of 7.44 on a venous blood gas. In the ED, her heart rate was in the low 100s beats per minute, respiratory rate of 18 breaths per minute, blood pressure of 136/79 mm Hg, and her O2 saturation was normal on room air. Her past medical history consists of GERD s/p laparoscopic Nissen fundoplication at age 15 and later RNYGB (10 years ago at another hospital), endometrioses, anxiety, and depression. Case PresentationĪ 30-year-old female presented to the emergency department (ED) with a rapid onset of abdominal pain along with swelling and bilateral lower extremity edema that progressed over three days. We present a case where RNYGB performed 10 years prior contributed to acute liver failure. A rare complication post-Roux-en-Y gastric bypass (RNYGB) is liver failure. ![]() These more commonly include nutrient deficiencies (vitamin B1, B12, iron, calcium), hernia, postprandial dumping syndrome, chronic kidney disease, and hypoglycemia. Despite the benefits of bariatric surgery, postoperative complications occur. Multiple investigators have shown bariatric surgery drastically decreases weight and body mass index (BMI) within the first year, along with eliminating the comorbidities mentioned above through improved glycemic and lipid control. Recently, bariatric surgery has grown in popularity due to its effectiveness in attaining persistent weight loss. Obesity is a pandemic that has been contributing to increased health care costs around the world due to the development of comorbidities such as non-alcoholic fatty liver disease (NAFLD), diabetes, and cardiovascular diseases.
0 Comments
Leave a Reply. |