K Alyatama, S Alqabandy, S Al ben Ali. Mubark Akabeer Hospital
Severe Malnutrition in gastric bypass patients requiring rapid correction resulting in a rare but riveting complication known as: Pontine Myelinolysis
Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the two most frequently performed bariatric operations. Both alter the anatomy and function of digestive tract producing significant weight reduction in morbidly obese patients.(1) This alteration makes patients more susceptible to developing nutritional complications, namely, deficiencies of macro- and micro-nutrients, which could lead to disabling diseases such as anemia, osteoporosis, protein malnutrition. (2)
The true balance of over and under nutrition in patients post gastric bypass surgery is now a global issue that is being faced by surgeons mainly during the follow-up period. Due to this major complication, research has now increased in this particular area to improve the overall knowledge of these complications.
This case study highlights how malnutrition and rapid correction may lead to life-threatening complications.
Malnutrition is a serious condition that occurs when a person’s diet doesn't contain the right amount of nutrients.It means "poor nutrition" and can refer to either under or overnutrition.(4)
Nutritional deficiencies can present with a wide range of clinical manifestations, depending on the specific nutrients/micronutrients that are involved, the severity, and the duration of the deficiency. As they may cause serious detriment to patients’ everyday lives and, in some instances, could result in life-threatening complications, a nutritional screening both before and after surgery is strongly recommended. (2)For most obese patients they tend to present with a number of nutritional deficits already prior to surgery. This finding prompts the need for a complete nutritional assessment and, eventually, an adequate correction of pre-existing deficits before surgery. (2)
This report highlights the case of a 31-year-old female patient that developed Pontine Myelinolysis following management of her severe vitamin, iron and albumin deficiencies post bariatric surgery. The intriguing concept presented Is that despite hyponatremia being the most common cause of pontine myelinolysis in this report, this is not the case. In this case as provided in the literature it may be due to reffeding syndrome as reports of hypophosphatemia leading to CPM.
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This abstract was accepted for Poster presentation at the 2020 SAGES Virtual Meeting in the Bariatric topic. Its program number was: P168 and its Abstract ID was: 102334