Bypass enteropathy. Intestinal and systemic manifestations following small-bowel bypass
E. J. Drenick, M. E. Ament, S. M. Finegold, P. Corrodi and E. Passaro
Many manifestations following jejunoileal bypass are due to chronic
inflammation of the excluded bowel rather than short bowel malabsorption.
Diarrhea, abdominal distention, and gas-fluid levels were common diagnostic
features of "bypass enteropathy." Exploration showed the bypassed bowel to
be dilated, with serosal inflammation and pneumatosis cystoides
intestinalis. The bypassed loops contained a fecal flora and the mucosa
demonstrated nonspecific chronic inflammatory changes. Exudative protein
losses were noted. Systemic complications of bypass enteropathy were
similar to other inflammatory diseases of the bowel. Improvement following
treatment with metronidazole or after dismantling of the bypass suggested
that bacterial byproducts originating in the excluded bowel were causally
related.
