Postgastrectomy blind loop syndrome: Megaloblastic anemia secondary to malabsorption of folic acid

Abstract

A patient who had undergone a gastrectomy with a roentgenologically demonstrated afferent loop syndrome and folate deficiency is described. Laboratory studies revealed the presence of steatorrhea, impaired vitamin B 12 absorption which did not respond to intrinsic factor administration, a normal serum vitamin B 12 level following parenteral administration of vitamin B 12, megaloblastic anemia, low serum folate levels and abnormal folic acid absorption. Administration of broad spectrum antibiotics resulted in normal fat absorption, normal vitamin B 12 absorption without intrinsic factor, and a normal folic acid absorption test result. The megaloblastic anemia in this patient appears to have resulted from folate deficiency and malabsorption of folic acid. The afferent loop syndrome and folic acid deficiency in patients with the blind loop syndrome and in postgastrectomy patients are reviewed.