Severe Calcium Malabsorption Following Biliopancreatic Diversion with Duodenal Switch. Case Report and Management.

Ibrahim M Ibrahim, MD, Jeffrey W Strain, MD, Celines Morales-Ribeiro, MD. Englewood Hospital & Medical Center

Calcium is normally absorbed actively by transcellular transport in the duodenum and passively in the jejunum and ileum (and to a much lesser extent in the colon) when dietary Calcium levels are elevated. Biliopancreatic diversion with duodenal switch (BPD-DS) bypasses the active mechanism rendering the patient dependent on passive absorption via a short ileal segment.

65 year old female was requiring increasing (and eventually intolerable) amounts of oral Calcium and Vitamin D during the ten years following BPD-DS surgery. She was also gaining weight due to enlarged sleeve. She underwent laparoscopic proximal entero-enterostomy between the alimentary and the biliopancreatic limbs (thus lengthening the common channel) and simultaneous revision of the sleeve. At two years follow-up the patient lost her (excess) regained weight and was taking minimal bariatric supplements with marked subjective improvement in her quality of life.

Restoring the absorptive capacity of the small bowel with one simple anastomosis avoids the more complex procedure of reversing the duodenal switch or lengthening the common channel. This approach may be applicable to other severe deficiencies of nutrients dependent on small bowel absorption.