Table 2.

Complications of jejunoileal bypass

Problem	Mechanism	Manifestations in this patient
Steatohepatitis Possible cirrhosis	Amino acid deficiency	Advanced liver disease with portal hypertension
Renal oxalosis	Excess oxalate absorption; Oxalate not bound by calcium	Multiple kidney stones and three previous lithotripsy interventions; Progressive kidney disease due to suspected oxalate nephropathy requiring lifelong hemodialysis
Fat soluble vitamin deficiency	Malabsorption; Steatorrhea	Serum levels:
		Vitamin A = 17 (360-200 mg/L)
		Vitamin D ≤ 10 (22-67 pg/mL)
		Vitamin E = 3 (5.5-17.0 mg/L)
		Vitamin K ≤ 0.03 (0.1-.2 ng/mL)
Gallstones	Bile acid loss; Mobilization of cholesterol	Previous cholecystectomy for symptomatic cholelithiasis
Enteritis	Bacterial overgrowth	30 years of diarrhea and steatorrhea Pneumatosis intestinalis
Arthritis	Bacterial toxin; Autoimmune	Bilateral knee and shoulder pain
Fatigue syndrome	Vitamin deficiency; Multifactorial	Marked fatigue, bed-ridden status
Bypass encephalopathy	Possible deficiency; Possible D-lactic acid deficiency	Slurred speech, incoordination and weakness
Bypass dermatitis	Possible antigen-antibody complex (enteric bacteria)	Cutaneous urticarial rash