An Uncommon Option for Surviving Bariatric Surgery: Regaining Weight!
In November 2011, a 32-year-old woman was admitted to the intensive care unit for acute respiratory failure. She had felt well consistently until February (including 2 pregnancies), when she underwent a noncomplicated sleeve gastrectomy for obesity (body mass index, 47 kg/m2). Her weight gain, unrelated to any endocrine disease, had started with adolescence and was resistant to all attempts to lose weight. One month after bariatric surgery and a loss of 20 kg, she had a first episode of constant and diffuse abdominal pain with slightly increased plasma concentration of lipase, and pancreatitis was diagnosed. Recurrent monthly vomiting episodes occurred later with abdominal and leg pains unrelated to her menstrual cycle. To counter postoperative deficiencies, she was fully supplemented with all vitamins. She had been treated regularly with analgesic drugs in an attempt to relieve erratic pain. Three weeks before admission, leg pains intensified, and tetraparesis developed over 2 days. On admission (6 months after surgery), her body mass index was 21 kg/m2 and heart rate was 135 beats/min. She had tetraparesis with diffuse allodynia and paresthesias, facial diplegia, and swallowing disorders with alveolar hypoventilation requiring mechanical ventilation.
Laboratory test results showed hypokalemia (2.6 mmol/L), hyponatremia (134 mmol/L), and moderately elevated liver enzymes (alanine aminotransferase 79 UI/L and aspartate aminotransferase 47 UI/L) without cholestasis. Renal function, blood counts, hemostasis, and Lyme serology were normal, as well as dosages of vitamins. Repeated cerebrospinal fluid examinations showed normal protein concentration without cells. Electromyography was compatible with severe motor axonal polyneuropathy. Magnetic resonance imaging showed focal cervical hyperintensity compatible with myelitis. Electroencephalography was normal.
Supportive care was given, and immunoglobulins were infused to treat a possible Guillain-Barre syndrome. No improvement was noted during the first few days.
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— François Danion, Max Guillot, MD, Vincent Castelain, MD, PhD, Hervé Puy, MD, PhD, Jean-Charles Deybach, MD, PhD, Francis Schneider, MD, PhD
–This article originally appeared in the November 2012 issue of The American Journal of Medicine.
