Table 2. Hepatic Complication in Patients Undergoing Roux-en-Y Gastric Bypass in the Literature and Our Case.
| Case 1 | Case 2 | Case 3 | Case 4 | Case 5 | Case 6 | Our case | |
|---|---|---|---|---|---|---|---|
| Reference | [4] | [4] | [5] | [5] | [5] | [7] | |
| Age (years) | 43 | 34 | 37 | 34 | 54 | 42 | 46 |
| Gender | Female | Female | Female | Female | Female | Female | Female |
| Surgery | Gastric bypass surgery, later revised to distal bypass | Sleeve gastrectomy failed followed by gastric bypass with persistent gastrojejunal ulcer | RNY-GBP with an extended Roux limb | RNY-GBP with an extended Roux limb | RNY-GBP with an extended Roux limb | RNY-GBP | RNY-GBP with standard Roux limb |
| Age at surgery (years) | 44 | 39 | 37 | 34 | 54 | 32 | 33 |
| Pre-surgery BMI (kg/m2) | 47 | 42 | 61 | 86 | 49 | N/A | 38 |
| Total weight loss (%) | 46% | 62% | 27% (48 kg) | 51% (128 kg) | 25% (35 kg) | N/A | 63% (57 kg) |
| Interval (months) | 30 | 33 | 7 | 17 | 7 | 120 | 156 |
| At admission | Developed hypoglycemia | Did not eat the days before hospitalization | Very limited oral intake, muscle wasting | Very limited oral intake, muscle wasting, weakness, fatigue, anasarca | Very limited oral intake, muscle wasting, weakness, jaundice | Poor nutritional intake, malodorous stools, wasting, anasarca, weeping blisters and erythema | Poor oral intake, wasting, anasarca, skin wounds |
| Encephalopathy | Yes | Yes | Yes | N/A | Yes | N/A | Yes |
| Hypoalbuminemia | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Hyperammonemia | Yes | Yes | Yes | N/A | Yes | N/A | Yes |
| HVPG | N/A | N/A | 25 | 30 | 30 | N/A | 12 |
| Treatment | Lactulose, rifaximin, enteral feeding | Lactulose, rifaximin, enteral feeding | Lactulose, nasoenteral feeding, metronidazole | Waiting for liver transplantation | Lactulose, nasoenteral feeding and metronidazole | N/A | Lactulose, enteral feeding, and ceftriaxone for urinary tract infection |
| Outcome | Died of progressive LF and multiorgan failure on D15 | Died of progressive LF on D2 | Alive | Alive | Died of gastric cancer | N/A | Died of liver failure |
| Liver biopsy | Not performed | Not performed | Massive steatosis and mild fibrosis | Steatosis, steatohepatitis, cirrhosis | Severe steatosis, steatohepatitis, and cirrhosis | Severe steatosis and inflammation without Mallory hyaline, consistent with steatohepatitis | Moderate steatosis, mild siderosis, abundant lipofuscin |
BMI: body mass index; HVPG: hepatic venous pressure gradient; RNY-GBP: Roux-en-Y gastric bypass; D: day; N/A: not available.