Late complications of biliopancreatic diversion in an older patient: a case report

Abstract Background In the mid-seventies, biliopancreatic diversion became popular as weight-loss surgery procedure. This bariatric procedure combines distal gastric resection and intestinal malabsorption, leading to greater weight loss and improvement of co-morbidities than other bariatric procedur...

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Autores principales:	Nele Steenackers, Elien Brouwers, Ann Mertens, Simon Van Cleynenbreugel, Matthias Lannoo, Johan Flamaing, Katleen Fagard
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Bariatric surgery Biliopancreatic diversion Elderly Dumping syndrome Neuroglycopenia Delirium Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/7c0cc2758dda45a6b07f1be7349460d6
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spelling	oai:doaj.org-article:7c0cc2758dda45a6b07f1be7349460d62021-11-07T12:16:30ZLate complications of biliopancreatic diversion in an older patient: a case report10.1186/s12877-021-02578-z1471-2318https://doaj.org/article/7c0cc2758dda45a6b07f1be7349460d62021-11-01T00:00:00Zhttps://doi.org/10.1186/s12877-021-02578-zhttps://doaj.org/toc/1471-2318Abstract Background In the mid-seventies, biliopancreatic diversion became popular as weight-loss surgery procedure. This bariatric procedure combines distal gastric resection and intestinal malabsorption, leading to greater weight loss and improvement of co-morbidities than other bariatric procedures. Nowadays, biliopancreatic diversion has become obsolete due to the high risk of nutritional complications. However, current patients with biliopancreatic diversions are aging. Consequently, geriatricians and general practitioners will encounter them more often and will be faced with the consequences of late complications. Case presentation A 74-year old female presented with weakness, recurrent falls, confusion, episodes of irresponsiveness, anorexia and weight loss. Her medical history included osteoporosis, herpes encephalitis 8 years prior and a biliopancreatic diversion (Scopinaro surgery) at age 52. Cerebral imaging showed herpes sequelae without major atrophy. Delirium was diagnosed with underlying nutritional deficiencies. Biochemical screening indicated vitamin A deficiency, vitamin E deficiency, zinc deficiency and severe hypoalbuminemia. While thiamin level and fasting blood glucose were normal. However, postprandial hyperinsulinemic hypoglycemia was observed with concomitant signs of confusion and blurred consciousness. After initiating parenteral nutrition with additional micronutrient supplementation, a marked improvement was observed in cognitive and physical functioning. Conclusions Long-term effects of biliopancreatic diversion remain relatively underreported in older patients. However, the anatomical and physiological changes of the gastrointestinal tract can contribute to the development of metabolic and nutritional complications that may culminate in cognitive impairment, functional decline and delirium. Therefore, it is warranted to evaluate the presence of metabolic disturbances and nutritional complications in older patients after biliopancreatic diversion.Nele SteenackersElien BrouwersAnn MertensSimon Van CleynenbreugelMatthias LannooJohan FlamaingKatleen FagardBMCarticleBariatric surgeryBiliopancreatic diversionElderlyDumping syndromeNeuroglycopeniaDeliriumGeriatricsRC952-954.6ENBMC Geriatrics, Vol 21, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Bariatric surgery Biliopancreatic diversion Elderly Dumping syndrome Neuroglycopenia Delirium Geriatrics RC952-954.6
spellingShingle	Bariatric surgery Biliopancreatic diversion Elderly Dumping syndrome Neuroglycopenia Delirium Geriatrics RC952-954.6 Nele Steenackers Elien Brouwers Ann Mertens Simon Van Cleynenbreugel Matthias Lannoo Johan Flamaing Katleen Fagard Late complications of biliopancreatic diversion in an older patient: a case report
description	Abstract Background In the mid-seventies, biliopancreatic diversion became popular as weight-loss surgery procedure. This bariatric procedure combines distal gastric resection and intestinal malabsorption, leading to greater weight loss and improvement of co-morbidities than other bariatric procedures. Nowadays, biliopancreatic diversion has become obsolete due to the high risk of nutritional complications. However, current patients with biliopancreatic diversions are aging. Consequently, geriatricians and general practitioners will encounter them more often and will be faced with the consequences of late complications. Case presentation A 74-year old female presented with weakness, recurrent falls, confusion, episodes of irresponsiveness, anorexia and weight loss. Her medical history included osteoporosis, herpes encephalitis 8 years prior and a biliopancreatic diversion (Scopinaro surgery) at age 52. Cerebral imaging showed herpes sequelae without major atrophy. Delirium was diagnosed with underlying nutritional deficiencies. Biochemical screening indicated vitamin A deficiency, vitamin E deficiency, zinc deficiency and severe hypoalbuminemia. While thiamin level and fasting blood glucose were normal. However, postprandial hyperinsulinemic hypoglycemia was observed with concomitant signs of confusion and blurred consciousness. After initiating parenteral nutrition with additional micronutrient supplementation, a marked improvement was observed in cognitive and physical functioning. Conclusions Long-term effects of biliopancreatic diversion remain relatively underreported in older patients. However, the anatomical and physiological changes of the gastrointestinal tract can contribute to the development of metabolic and nutritional complications that may culminate in cognitive impairment, functional decline and delirium. Therefore, it is warranted to evaluate the presence of metabolic disturbances and nutritional complications in older patients after biliopancreatic diversion.
format	article
author	Nele Steenackers Elien Brouwers Ann Mertens Simon Van Cleynenbreugel Matthias Lannoo Johan Flamaing Katleen Fagard
author_facet	Nele Steenackers Elien Brouwers Ann Mertens Simon Van Cleynenbreugel Matthias Lannoo Johan Flamaing Katleen Fagard
author_sort	Nele Steenackers
title	Late complications of biliopancreatic diversion in an older patient: a case report
title_short	Late complications of biliopancreatic diversion in an older patient: a case report
title_full	Late complications of biliopancreatic diversion in an older patient: a case report
title_fullStr	Late complications of biliopancreatic diversion in an older patient: a case report
title_full_unstemmed	Late complications of biliopancreatic diversion in an older patient: a case report
title_sort	late complications of biliopancreatic diversion in an older patient: a case report
publisher	BMC
publishDate	2021
url	https://doaj.org/article/7c0cc2758dda45a6b07f1be7349460d6
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Late complications of biliopancreatic diversion in an older patient: a case report

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