Parotid Hypertrophy and Bariatric Surgery: Case Report

Abstract

Approximately 5% of the United States population is morbidly obese, with morbid obesity defined as a body mass index (BMI) greater than 40. (BMI is determined by dividing a patient’s weight in kilograms by the square of the height in meters.) Because morbid obesity is associated with early mortality and various adverse health conditions, including type 2 diabetes mellitus, hypertension, hyperlipidemia, sleep apnea, heart disease, stroke, asthma, and bone degeneration in weight-bearing areas, therapeutic intervention is indicated. Conservative therapy, including dietary changes, exercise, behavioral modification, and pharmacotherapy, will result in weight loss, but this loss is often transient. Bariatric surgery (the surgical management of obesity) has become a common therapeutic approach for morbidly obese persons who do not respond to conservative approaches. This approach is increasing in popularity, with 72,000 procedures performed in 2002 and an estimated 103,000 in 2003, and continued increases expected. Bariatric surgery comprises a variety of gastric surgical techniques. The most common procedure involves stapling to form a stomach pouch with a 50to 100-mL capacity and creating an anastomosis to the upper jejunum, forming a 1to 2-cm–diameter stoma. The consequent reduced stomach size encourages satiety, while the small stoma delays pouch emptying and the return of hunger. Although bariatric surgery has proven generally successful in alleviating the systemic conditions associated with morbid obesity, postoperative complications can occur. Persistent vomiting (several times a day) has been reported in as many as 30% of patients and should not be considered normal. Often dietary indiscretion, with constant snacking, a continued increase in food intake, and failure to chew small amounts of food slowly and thoroughly, will lead to pouch distention with pain and vomiting. Psychiatric factors also come into play in these patients, who frequently have fragile psyches. Self-induced vomiting after gastric surgery is a known mechanism to alleviate stress in some patients. Here we report a patient who engaged in selfinduced vomiting after bariatric surgery performed 26 years earlier. Because bariatric surgery has become a common procedure for morbidly obese persons, the authors wish to call attention with this case report to an oral-facial symptom, parotid gland hypertrophy, that may develop.