Abstract
The development of bowel-bypass syndrome complicating the Whipple procedure for biliary tract carcinoma is described here for the first time. A 56-year-old HLA-B27 + man, treated with excision of adenocarcinoma of the ampulla of Vater, developed an undifferentiated spondyloarthropathy, initially unresponsive to nonsteroidal anti-inflammatory drugs and doxycycline, but eventually controlled with sulfasalazine and tapered corticosteroids. This condition represents another example of a rheumatic syndrome occurring after disruption of gastrointestinal tract continuity and likely development of small bowel bacterial overgrowth.
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