Calciphylaxis: a rare but fatal delayed complication of Roux-en-Y gastric bypass surgery.
Gastric bypass is a commonly used surgical procedure that has shown impressive health benefits for patients with morbid obesity. However, mineral bone abnormalities (hypocalcemia, hypovitaminosis D, and secondary hyperparathyroidism) and micronutrient (e.g., iron) deficiencies are common complications after gastric bypass surgery due to alterations in the digestive anatomy. These abnormalities, their treatments, and a number of other factors associated with obesity can set up a perfect storm to induce calciphylaxis, a rare but highly fatal condition with severe comorbid conditions. We present a fatal case of nonuremic calciphylaxis coincident with symptomatic hypocalcemia in a morbidly obese man with a history of Roux-en-Y gastric bypass surgery.
Division of Nephrology, Massachusetts General Hospital, Boston, MA.
Andrew S
AS
Allegretti
Dermatopathology Unit, Pathology Service, Massachusetts General Hospital, Boston, MA.
Rosalynn M
RM
Nazarian
Department of Surgery, Massachusetts General Hospital, Boston, MA.
Jeremy
J
Goverman
Division of Nephrology, Massachusetts General Hospital, Boston, MA. Electronic address: sagarnigs@gmail.com.
Sagar U
SU
Nigwekar
D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects*; D002115:Calciphylaxis / Q000175:diagnosis / Q000209:etiology*; D017809:Fatal Outcome; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*
Calciphylaxis; gastric bypass; hypocalcemia; obesity; vitamin D