Late complications of biliopancreatic diversion in an older patient: a case report

BMC Geriatrics

Nele Steenackers¹  Matthias Lannoo²  Ann Mertens³  Katleen Fagard⁴  Johan Flamaing⁴  Elien Brouwers⁵  Simon Van Cleynenbreugel⁶ 

[1] Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium;Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium;Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium;Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium;Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium;Department of Geriatric Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium;Department of Geriatric Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium;

关键词: Bariatric surgery;    Biliopancreatic diversion;    Elderly;    Dumping syndrome;    Neuroglycopenia;    Delirium;    Malnutrition;    Nutritional deficiencies;   

DOI  :  10.1186/s12877-021-02578-z

来源: Springer

【 摘 要 】

BackgroundIn the mid-seventies, biliopancreatic diversion became popular as weight-loss surgery procedure. This bariatric procedure combines distal gastric resection and intestinal malabsorption, leading to greater weight loss and improvement of co-morbidities than other bariatric procedures. Nowadays, biliopancreatic diversion has become obsolete due to the high risk of nutritional complications. However, current patients with biliopancreatic diversions are aging. Consequently, geriatricians and general practitioners will encounter them more often and will be faced with the consequences of late complications.Case presentationA 74-year old female presented with weakness, recurrent falls, confusion, episodes of irresponsiveness, anorexia and weight loss. Her medical history included osteoporosis, herpes encephalitis 8 years prior and a biliopancreatic diversion (Scopinaro surgery) at age 52. Cerebral imaging showed herpes sequelae without major atrophy. Delirium was diagnosed with underlying nutritional deficiencies. Biochemical screening indicated vitamin A deficiency, vitamin E deficiency, zinc deficiency and severe hypoalbuminemia. While thiamin level and fasting blood glucose were normal. However, postprandial hyperinsulinemic hypoglycemia was observed with concomitant signs of confusion and blurred consciousness. After initiating parenteral nutrition with additional micronutrient supplementation, a marked improvement was observed in cognitive and physical functioning.ConclusionsLong-term effects of biliopancreatic diversion remain relatively underreported in older patients. However, the anatomical and physiological changes of the gastrointestinal tract can contribute to the development of metabolic and nutritional complications that may culminate in cognitive impairment, functional decline and delirium. Therefore, it is warranted to evaluate the presence of metabolic disturbances and nutritional complications in older patients after biliopancreatic diversion.

【 授权许可】

CC BY