Liver injury due to jejunoileal bypass. Pathological and pathogenetic aspects
Marescaux, J.; Doffoël, M.; Raul, F.; Petit, B.; Diemunsch, P.; Warter, A.; Grenier, J.F.
Gastroenterologie Clinique et Biologique 5(11): 1039-1046
1981
ISSN/ISBN: 0399-8320 PMID: 7308675 Document Number: 179334
A patient who underwent end-to-end jejunoileal anastomosis for massive obesity and subsequently died of hepatic failure is presented. The overall incidence of fatal hepatic failure following this operation is 2-3%. The etiology of hepatic dysfunction is obscure. A deleterious role of the excluded loop, choline deficiency and altered bile acid metabolism have been incriminated. The most attractive mechanism would be protein malnutrition. A selective increase in levels of disaccharidase enzymes in the brush border membrane of the remaining intestinal mucosa was recently demonstrated. If relative protein deficiency as well as preferential absorption of carbohydrate are present in patients with jejunoileal bypass, similarities could exist between hepatic lesions observed in these patients and the lesions observed in patients with the kwashiorkor syndrome. Additional findings suggest that the mechanism of hepatic changes following jejunoileal bypass may be close to that of hepatic lesions due to alcohol.