title: Liver failure in an obese middle-aged woman after biliointestinal bypass.
abstract: Obesity is considered an emerging epidemic that is often associated with non-alcoholic fatty liver disease. Among the therapeutic options for morbid obesity, bariatric surgery plays an important role when conventional therapies fail. The effects of bariatric surgery on liver function and morphology are controversial in the literature. Liver failure has been reported after jejunoileal bypass (JIB), biliopancreatic diversion and gastric bypass. Biliointestinal bypass (BIB) is considered an effective procedure among recently introduced bariatric surgery techniques. It is a clinically safe, purely malabsorptive operation in which the blind intestinal loop of the JIB is anastomosed to the gallbladder, allowing a portion of bile to transit into excluded intestinal tract. BIB is the only procedure, to our knowledge, to have no liver side effects reported in the literature. We report the case of a young obese woman who developed liver failure 8 mo after BIB. She had a rapid weight loss (70 kg) with a reduction in body mass index of 41% from January to September 2012. Because of a severe hepatic decompensation, she was referred to a transplantation centre. We strongly believe that the most important pathogenetic mechanism involved in the development of liver injury is the rapid weight loss that produced a significant fatty liver infiltration.
authors.affiliation: Dolores Sgambato, Gaetano Cotticelli, Ilario de Sio, Annalisa Funaro, Anna Del Prete, Chiara de Sio, Lorenzo Romano, Alessandro Federico, Antonietta Gravina, Agnese Miranda, Carmelina Loguercio, Marco Romano, Department of Clinical and Experimental Medicine "Magrassi-Lanzara", Gastroenterology Unit, Second University of Naples, 80131 Naples, Italy.
authors.forename: Dolores
authors.initials: D
authors.lastname: Sgambato
authors.forename: Gaetano
authors.initials: G
authors.lastname: Cotticelli
authors.forename: Ilario
authors.initials: I
authors.lastname: de Sio
authors.forename: Annalisa
authors.initials: A
authors.lastname: Funaro
authors.forename: Anna
authors.initials: A
authors.lastname: Del Prete
authors.forename: Chiara
authors.initials: C
authors.lastname: de Sio
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Romano
authors.forename: Alessandro
authors.initials: A
authors.lastname: Federico
authors.forename: Antonietta
authors.initials: A
authors.lastname: Gravina
authors.forename: Agnese
authors.initials: A
authors.lastname: Miranda
authors.forename: Carmelina
authors.initials: C
authors.lastname: Loguercio
authors.forename: Marco
authors.initials: M
authors.lastname: Romano
keywords: Bariatric surgery; Biliointestinal bypass; Liver failure; Non-alcoholic fatty liver disease; Obesity; Rapid weight loss