A multihit cascade of late complications after Roux-en-Y gastric bypass leading to refractory malnutrition: a case report
Abstract
Introduction and importance: Roux-en-Y gastric bypass (RYGB) is an effective metabolic procedure with durable weight loss and metabolic benefits. However, catastrophic late-onset malnutrition is rarely reported, particularly when multiple long-term complications interact sequentially. We present a case illustrating a multihit cascade of skeletal and gastrointestinal events culminating in life-threatening refractory malnutrition long after RYGB.
Presentation of case: A 67-year-old woman with a history of RYGB for severe obesity developed an osteoporosis-related fragility fracture, followed by prolonged immobilization. During subsequent hospitalization, she experienced stress- and medication-induced marginal ulceration, complicated by perforation and prolonged fasting. These events collectively precipitated profound macro- and micronutrient deficiencies that were refractory to conventional oral and parenteral supplementation. The patient was managed with intensive nutritional rehabilitation, including combined enteral feeding via the oral route and a feeding gastrostomy, alongside parenteral nutritional support. Recovery was markedly protracted, underscoring the severity and refractoriness of the nutritional derangement.
Clinical discussion: This case demonstrates that patients who have undergone RYGB remain vulnerable to delayed, synergistic complications arising from altered gastrointestinal anatomy, impaired absorptive capacity, chronic acid suppression, and age-related…
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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