Atrophic beriberi: A complication of jejunoileal bypass surgery for morbid obesity

Abstract

Four months after jejunoileal bypass surgery for morbid obesity, a 37 year black woman who ate a grossly inadequate diet was hospitalized complaining of diffuse abdominal pain, complete loss of appetite, burning feet, generalized weakness and inability to walk without assistance; she had had a weight loss of 100 pounds. Physical findings were limited to the neurologic examination and revealed bilateral glove hypesthesia to midforearms, bilateral stocking hypesthesia to the ankles and partial loss of all sensory modalities. She also had distal muscle weakness with inability to make a firm fist or to stand without assistance. Routine laboratory studies were not diagnostic. She was admitted to the surgical service with a diagnosis of electrolyte imbalance secondary to gastrointestinal losses; she was fed a high-protein diet as tolerated and given intravenous electrolyte therapy, but her neurologic condition deteriorated severely over a two week period. She had a complete loss of deep tendon reflexes in all extremities; the extent of sensory loss increased slightly and motor function disappeared completely below the knees with minimal function in the thighs. Hip motion remained normal. Finger and wrist extension were absent and flexion was very poor, although shoulder and central nervous system functions were all intact. Several serum vitamin studies made at that time showed only a severe depletion of thiamine. Atrophic beriberi secondary to jejunoileal bypass surgery and poor diet was appreciated for the first time. Replacement therapy with thiamine followed by an elemental diet containing all essential nutrients administered through a jejunostomy tube resulted in gradual improvement. Atrophic beriberi should be suspected whenever peripheral neuropathy develops after jejunoileal bypass for morbid obesity.