scholarly journals Third reported case of rare necrolytic migratory erythema associated with bacteraemia due to severe zinc deficiency after revisional Roux-En-Y gastric bypass: case report and literature review

Author(s):  
Yassmin Salaheldin ◽  
Walid El Ansari ◽  
Esraa Aljaloudi ◽  
Wahiba Elhag

Abstract Introduction Obesity is a risk factor for zinc deficiency. After bariatric surgery, non-compliance to diet/vitamin supplements, surgical complications leading to vomiting/diarrhea, poor follow-up and malabsorption can precipitate or exacerbate pre-existing zinc deficiency. Case report We report a patient with rare necrolytic migratory erythema associated with bacteraemia due to severe zinc deficiency after revisional Roux-en-Y gastric bypass (following primary laparoscopic sleeve gastrectomy). Conclusion Bariatric teams should screen patients before bariatric surgery for nutritional deficiencies and continue surveillance of their nutritional status after surgery. They should maintain a high index of suspicion for zinc deficiency in patients with skin rash after bariatric surgery. Level of evidence Level V, case report.

2021 ◽  
Vol 12 ◽  
Author(s):  
Aura D. Herrera-Martínez ◽  
Sonia Junquera-Bañares ◽  
Lucía Turrión-Merino ◽  
Francisco Arrieta-Blanco ◽  
José Botella-Carretero ◽  
...  

Bariatric surgery is one of the most effective treatments currently available for obesity and its derived comorbidities. However, complications may occur, especially when malabsorptive surgeries like a biliopancreatic diversion is performed. We present the case of a female patient whose obesity was treated with this technique, and in the 9th year of follow-up developed an extensive dermatitis secondary to zinc deficiency and malnutrition, precipitated by therapeutic non-compliance. A close surveillance of early symptoms and signs of nutritional deficiencies as well as chronic supplementation of vitamins and trace elements is required; this case illustrates the relevance of periodical, lifelong visits to a medical physician with special training and experience in the management of post bariatric surgery patients in order to prevent, diagnosis and early treat related complications.


2015 ◽  
Vol 8 (1) ◽  
pp. 27 ◽  
Author(s):  
Mauro Akira Suizu ◽  
Romir Rodrigues ◽  
Juliana Isa Beraldo

A obesidade, doença crônica e complexa, acomete cada vez mais a população. Devido ao tratamento difícil, a cirurgia bariátrica, quando indicada, é eficiente, pois apresenta baixos riscos aos pacientes e boa manutenção da perda de peso. Entretanto, deve-se ter atenção no pós-operatório, devido aos efeitos colaterais promovidos pela cirurgia, resultando em modificações metabólicas e falhas nutricionais, decorrente da má absorção de nutrientes, dentre eles, o ferro. O objetivo da pesquisa foi avaliar a prevalência de anemia ferropriva no período de junho a outubro de 2013, com 32 pacientes submetidos à cirurgia bariátrica do tipo Y de Roux, pertencentes à Associação dos Obesos Operados Bariátricos de Paranavaí e Região (AOOB). Após realizarmos um comparativo parcial com os 32 bariátricos da comunidade, verificarmos deficiências nutricionais. Nos 32 pacientes da comunidade, 50% manifestaram anemia, com IMC 23,37 kg/m2 (21,41 ± 25,33) e idade média de 43 anos. Já na AOOB, 31,25% apresentaram anemia (com maior prevalência dois anos após a cirurgia), IMC 29,02 kg/m2 (24,80 ± 33,24) e idade média de 42,96 anos. Nos associados da AOOB, 46,87% possuem intolerância a carne vermelha; 65% usam suplementos nutricionais e a participação nas reuniões mensais variou de 113 a 32 presenças. Apesar do estudo ter revelado índices relevantes de anemia é essencial o acompanhamento pós-operatório, como o realizado pela AOOB, melhorando a qualidade de vida dos pacientes. No entanto, é necessário um estudo mais abrangente, com espaço amostral e período de tempo maior para solidificação das evidências aqui estudadas. Verification of Anemia in Patients with Bariatric Surgery (Roux-En-Y Gastric Bypass) Obesity, a chronic and complex disease, is more and more common in the population. Due to difficult treatment of obesity, bariatric surgery is efficient since it provides a good weight loss with few risks to patients. The post-operation period is important due to the side effects caused by metabolic modifications and nutritional flaws from a bad absorption of nutrients, especially iron. Current research, undertaken between June and October 2013, assesses the prevalence of iron-insufficiency anemia in 32 patients who underwent Roux-en-Y gastric bypass, belonging to the Association of Operated Obese People (AOOB) from the region of Paranavaí PR Brazil. Partial comparative exam with 32 bariatric patients showed nutritional deficiencies, or rather, 50% suffered from anemia, with BMI = 23.37 kg/m2 (21.41 ± 25.33) and average age 43 years, whereas in AOOB, 31.25% were anemic (after two years of surgery), IMC = 29.02 kg/m2 (24.80 ± 33.24) and mean age 42.96 years. Further, 46.87% of AOOB associates were non-tolerant to beef; 65% used nutrition supplements and participation in monthly meetings varied between 113 and 32. In spite of high anemia percentages, the post-operational follow-up is highly important since it improves the patients ́ lifestyle. However, a more comprising analysis is required with a bigger sample and a longer time span for the establishment of evidences.


2021 ◽  
Author(s):  
Arnaud Liagre ◽  
Francesco Martini ◽  
Radwan Kassir ◽  
Gildas Juglard ◽  
Celine Hamid ◽  
...  

Abstract Purpose The treatment of people with severe obesity and BMI > 50 kg/m2 is challenging. The present study aims to evaluate the short and mid-term outcomes of one anastomosis gastric bypass (OAGB) with a biliopancreatic limb of 150 cm as a primary bariatric procedure to treat those people in a referral center for bariatric surgery. Material and Methods Data of patients who underwent OAGB for severe obesity with BMI > 50 kg/m2 between 2010 and 2017 were collected prospectively and analyzed retrospectively. Follow-up comprised clinical and biochemical assessment at 1, 3, 6, 12, 18, and 24 months postoperatively, and once a year thereafter. Results Overall, 245 patients underwent OAGB. Postoperative mortality was null, and early morbidity was observed in 14 (5.7%) patients. At 24 months, the percentage total weight loss (%TWL) was 43.2 ± 9, and percentage excess weight loss (%EWL) was 80 ± 15.7 (184 patients). At 60 months, %TWL was 41.9 ± 10.2, and %EWL was 78.1 ± 18.3 (79 patients). Conversion to Roux-en-Y gastric bypass was needed in three (1.2%) patients for reflux resistant to medical treatment. Six patients (2.4%) had reoperation for an internal hernia during follow-up. Anastomotic ulcers occurred in three (1.2%) patients. Only two patients (0.8%) underwent a second bariatric surgery for insufficient weight loss. Conclusion OAGB with a biliopancreatic limb of 150 cm is feasible and associated with sustained weight loss in the treatment of severe obesity with BMI > 50 kg/m2. Further randomized studies are needed to compare OAGB with other bariatric procedures in this setting. Graphical abstract


2021 ◽  
Vol 1 (5) ◽  
Author(s):  
Jayanth Moode ◽  
◽  
KASSN Kalyan ◽  
Lakshmi Kona ◽  
◽  
...  

Introduction: Gastrointestinal (GI) leaks are one of the most dreaded complications following bariatric surgery because of the difficulty in diagnosing them and the associated increased morbidity and mortality. Case report: Presenting one such case of 49 yr old gentleman who was on follow-up post bariatric surgery presented lately as acute abdomen and diagnosed as GI perforation and further evaluation and procedure carried out. Discussion: GI leakage after bariatric surgery has been identified as an independent risk factor associated with perioperative death. This highlights the importance of high index of suspicion for diagnosis of this potentially lethal complication. A positive radiology should not be awaited for before exploring patients in whom the diagnosis is still unclear. Conclusion: Histopathologic examination (HPE) remains one of the major diagnostic tools in mycology because it permits rapid, presumptive identification of fungal infections, even when blood cultures are negative. There are different ways to manage leaks, depending on the magnitude of the collection and the clinical presentation. Keywords: surgical pathology; gastrointestinal candidiasis; diagnosis; mini gastric bypass; bariatric surgery; candida.


2021 ◽  
pp. 1-3
Author(s):  
Gulay Kocak ◽  
Munevver Gul Avsar ◽  
Cansu Yazar ◽  
Aylia Yesilova ◽  
Gulcagri Yildiz ◽  
...  

Background: Sleeve gastrectomy for weight loss has increased significantly nowadays. Various complications may develop after this surgery that requires long-term follow-up of these patients. Nutrition is the most important aspect of the follow-up. The deficiency of trace elements, fat-soluble and water-soluble vitamins following bariatric surgeries have been well-described complications. Although nutritional supplementations are often initiated after bariatric surgery, the clinical outcomes related to the deficiency of trace elements have not been well known yet. Case Presentation: A 27-year-old woman who underwent a laparoscopic sleeve gastrectomy for surgical treatment of obesity 9 months ago presented to the emergency department with a signs of heart failure. Transthoracic echocardiography revealed dilated, poorly functioning left ventricle with reduced ejection fraction (28.9%) consistent with dilated cardiomyopathy. We assumed nutritional deficiencies secondary to sleeve gastrectomy as a cause of dilated cardiomyopathy, as the patient had inappropriate nutritional supplements after surgery. Laboratory tests revealed selenium and zinc deficiency that supported our hypothesis. Our patient completely recovered with adequate supplementation of selenium, zinc and thiamine. Conclusion: We highlighted that the early diagnosis of dilated cardiomyopathy due to selenium deficiency following bariatric surgery is of great importance since selenium deficiency is a cause of reversible cardiomyopathy.


Author(s):  
Anthony B. Mozer ◽  
Konstantinos Spaniolas ◽  
Walter J. Pories

Dietary intolerance and poor oral intake account for a disproportionate number of emergency department visits and readmissions after bariatric surgery. Micronutrient, vitamin, and protein deficiencies can occur after both malabsorptive and restrictive weight-loss operations, and they are best mitigated against by conscientious preoperative counseling and vigilance in follow-up. Routine vitamin supplementation can prevent the need for unnecessary laboratory testing, while symptoms of dumping syndrome can frequently be managed with dietary and behavioral modification alone. Alternative enteral feeding access for alimentary supplementation can be safely performed surgically or with assistance by interventional radiology, and should be considered in the management of perforation, early anastomotic leak, surgical revision, or patients with refractory malnourishment.


2014 ◽  
Vol 4 (3) ◽  
pp. 24707 ◽  
Author(s):  
Dariush Shahsavari ◽  
Zubair Ahmed ◽  
Ajoy Karikkineth ◽  
Richard Williams ◽  
Carlos Zigel

2017 ◽  
Vol 25 (3) ◽  
pp. 103-106 ◽  
Author(s):  
Jorge Henrique Assunção ◽  
Eduardo Angeli Malavolta ◽  
Mauro Emilio Conforto Gracitelli ◽  
Renée Zon Filippi ◽  
Arnaldo Amado Ferreira Neto

ABSTRACT Multifocal osteonecrosis is a rare disease; chronic use of corticosteroids is considered the main risk factor. Patients with chronic renal failure can develop aluminum toxicity, which can lead to osteomalacia and encephalopathy. An association between osteonecrosis and aluminum toxicity has been reported among patients with dialytic renal insufficiency. Occupational exposure to aluminum rarely causes lung disease and no cases of bone lesions resulting from exposure to this metal have been reported. In this manuscript, we describe a novel case of a patient with multifocal osteonecrosis associated with chronic occupational exposure to aluminum. Level of Evidence IV, Case Report.


2020 ◽  
Vol 5 (7) ◽  
pp. 190-193
Author(s):  
Dr. Usha BR. ◽  
◽  
Dr. Nandhini K ◽  
Dr. Chaitra MC ◽  
◽  
...  

Myasthenia gravis (MG) is a rare autoimmune disorder affecting neuromuscular junction by muscleweakness. Myasthenia gravis can be generalized or localized as ocular myasthenia gravis. Casepresentation: We report an 8-year-old boy who presented with 10 days history of drooping of botheyelids and 8 days history of diplopia. Examination revealed bilateral ptosis. A diagnosis of JuvenileOcular Myasthenia gravis was made when symptoms improved with intramuscular Edrophoniumadministration. He was commenced on oral Neostigmine at a dose of 2mg/Kg/ day,4 hourly individed doses and is on regular follow up and had a good response. Conclusion: Ocular Myastheniagravis (OMG) is a rare disease in itself. A high index of suspicion is required in a juvenile as it iseven rarer.


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