Severe Hypoalbuminaemia after Roux-En-Y Gastric Bypass: A Diagnosis of Exclusion.

Q3 Medicine
European journal of case reports in internal medicine Pub Date : 2025-08-25 eCollection Date: 2025-01-01 DOI:10.12890/2025_005741
Catarina Santos Reis, Ana Filipa Lopes, Francisco Santos Dias, Marta Soares Carreira, Jorge Almeida
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引用次数: 0

Abstract

Bariatric surgery has emerged as a highly effective treatment option for individuals with obesity. Severe hypoalbuminaemia is a feared complication after a Roux-en-Y gastric bypass. It is characterised by a low serum albumin level of <25 g/l, neither explained by renal losses, protein-losing enteropathy nor by liver disfunction, and is associated with high morbidity and mortality. Prompt workup leading to the diagnosis and aggressive treatment are recommended to prevent rapid clinical worsening; however, evidence-based recommendations and specific treatment approach are lacking. Most cases can be managed with dietary counselling and protein-enhanced oral supplements. We report a case of a female patient in her 50s with class II obesity, who underwent a Roux-en-Y gastric bypass eight months earlier, who presented to the Emergency Department with new onset of asthenia and lower limb oedema. Her biochemistry panel revealed severe serum hypoalbuminaemia, with a level of 18.4 g/l. After a thorough examination, complete laboratory tests and imaging that excluded renal and gastrointestinal losses and hepatic disfunction, she was presumed to have developed severe hypoalbuminemia after bariatric intervention. She managed to increase her oral intake of protein-enhanced products, according to nutritional counselling. At a six-month follow-up visit the patient regained 1% of the weight and had a slow and progressive increase in the serum albumin level. Our report highlights the importance of continuous nutritional monitoring and a multidisciplinary approach in the post-operative period of bariatric surgery to improve long-term outcomes.

Learning points: Severe hypoalbuminaemia caused by bariatric surgery requires exclusion of alternative aetiologies.Surgical reversal can often be avoided by appropriate dietary interventions.

Roux-En-Y胃旁路术后严重低白蛋白血症:排除诊断。
减肥手术已经成为肥胖患者的一种非常有效的治疗选择。严重的低白蛋白血症是Roux-en-Y胃旁路手术后令人担忧的并发症。其特点是血清白蛋白水平低,学习点:由减肥手术引起的严重低白蛋白血症需要排除其他病因。通过适当的饮食干预通常可以避免手术逆转。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.10
自引率
0.00%
发文量
166
审稿时长
8 weeks
期刊介绍: The European Journal of Case Reports in Internal Medicine is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from 33 European countries. The Journal''s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field. EJCRIM welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight and/or contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors). The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.
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