title: A patient with profound weight loss after gastric bypass surgery: A case report.
abstract: BACKGROUND
  A case of profound weight loss after gastric bypass surgery with multiple negative evaluations.
  
  
  METHODS
  A 41-year-old African-American female presented with greater-than-expected weight loss after gastric bypass and increasing abdominal pain over a 2-year period. An extensive workup was pursued for the patient with blood analysis, tumor markers, imaging studies both computed tomography and magnetic resonance imaging, arterial studies, and endoscopy from above and below, all of which demonstrated normal results. The patient was followed up without improvement, and repeated studies were also normal. The patient was labeled with a nonorganic etiology for her symptoms, which led to a psychiatry referral which was refused.
  
  
  CONCLUSIONS
  The patient's surgeon, who already had removed a normal appendix and gallbladder, repeated a laparoscopic exam. The exam was normal except for a small focus of pancreatic cancer in the celiac plexus. The patient died from perioperative sepsis from peritonitis 2 days after surgery. The case is discussed and findings reviewed.
authors.affiliation: Department of Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Flannery
keywords: Pancreatic cancer; abdominal pain; cachexia; metastasis; weight loss