Short bowel syndrome after Billroth II gastric resection

A 46 years old woman with symptoms of severe malabsorption was admitted to our hospital.

The patient was operated on Billroth I gastric resection because of gastric ulcer in 1984. Abdominal wall plastic surgery was carried out in 1985. Billroth II resection was performed because of anastomosis stenosis in 1985. The complaints of diarrhea, steatorrhea and malabsorption started after the third operation. She was treated with total parenteral nutrition several times. At the admission hypoproteinemia (37,8g/l), hypoalbuminemia (15,1g/l), hypocalcaemia (1,08 mmol/l), iron deficiency (3,4 umol/l), hypophosphatemia (0,84 mmol/l), normochrom, normocytic anemia was found, with normal absolute lymphocyte number (2,8 G/l). An anastomosis was detected at 95cm distance from the teeth in the efferent loop of Billroth II resected stomach by routine upper GI endoscopy. Cascade biopsy from the small intestine revealed normal structure of the intestinal villi. Jejuno-ileal anastomosis was suggested by barium X-ray, that was not properly informative because of superposition of the bowels. Endocrine and metabolic disorders, primary mucosal absorptive defects, cardiovascular disorders, lymphatic obstruction, postgastrectomy diarrhea, bacterial overgrowth syndrome and infective diarrhea were earlier closed out. Thus the picture of a short bowel syndrome caused by jejuno-ileal bypass was found.