SADI-S TO RYGB DUE TO SEVERE PROTEIN MALNUTRITION, WITH KWASHIORKOR SYNDROME.

Slot ID

PE135

Abstract Title

Author Details

No. of Authors

8

Including the presenting author

Author 1

Ramon Vilallonga ramon.vilallonga@vallhebron.cat Hospital Universitari Vall d'Hebron General and Digestive Surgery Departmen Barcelona Spain *

Author 2

Carlos Petrola carlosgustavo.petrola@vallhebron.cat Hospital Universitari Vall d'Hebron General and Digestive Surgery Departmen Barcelona Spain

Author 3

Daniel Herms daniel.herms@vallhebron.cat Hospital Universitari Vall d'Hebron General and Digestive Surgery Departmen Barcelona Spain

Author 4

Alba Martin alba.martin@vallhebron.cat Hospital Universitari Vall d'Hebron General and Digestive Surgery Departmen Barcelona Spain

Author 5

Sana Khan sanaaijaz.khan@vallhebron.cat Hospital Universitari Vall d'Hebron General and Digestive Surgery Departmen Barcelona Spain

Author 6

Ricardo Beltrán ricardo.abm95@gmail.com Centro Médico ABC General and Digestive Surgery Departmen Ciudad de México Mexico

Author 7

Ermer Elizondo eeeeermr@gmail.com Centro Médico ABC General and Digestive Surgery Departmen Ciudad de México Mexico

Author 8

Gonzalo Sapisochin gonzalo.sapisochin@vallhebron.cat Hospital Universitari Vall d'Hebron General and Digestive Surgery Departmen Barcelona Spain

Author 9

Author 10

Author 11

Author 12

Presenting Author Name

Ramon Vilallonga

Presenting Author Email

vilallongapuy@gmail.com

Presenting Author Country

Spain

Abstract

Abstract type

Video

Introduction *

Bariatric surgery is an effective treatment for severe obesity and related comorbidities, but some procedures, such as single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), may cause severe protein malnutrition in high-risk patients. Early recognition and adequate management, including revisional surgery, are crucial to avoid life-threatening consequences.

Material & Method *

We report the case of a 61-year-old woman with hypertension and triple-positive antiphospholipid syndrome on warfarin, and severe obesity (BMI 51). She underwent sleeve gastrectomy in 2022, achieving limited weight loss (BMI 43), and was converted to SADI-S in 2023. In September 2024, she presented with dyspnea, peripheral edema, and ascites. Laboratory tests showed severe anemia, hypoalbuminemia, undetectable prealbumin, and protein-energy malnutrition consistent with Kwashiorkor syndrome. CT imaging revealed pleural and pericardial effusions, ascites, and marked third-spacing. Endoscopy showed grade D esophagitis without anatomical abnormalities. The patient was admitted for intensive nutritional optimization with parenteral support, diuretics, and blood transfusions.

Results *

After 4 weeks, revisional surgery was performed, converting SADI-S to Roux-en-Y gastric bypass (RYGB) with hiatal hernia repair. The surgery was uneventful, and she was discharged on postoperative day 3. At 2 months, her nutritional status markedly improved, with normalized laboratory values and no complications.

Conclusion *

This case underscores the importance of vigilant nutritional monitoring after bariatric surgery. In selected high-risk patients, revisional surgery from SADI-S to RYGB, preceded by careful preoperative optimization, represents an effective therapeutic approach for resolving severe protein malnutrition and its complications.

File Upload #1

Only accept images in .jpg or .png format. The image size must not exceed 1 MB.

File Upload #2

Only accept images in .jpg or .png format. The image size must not exceed 1 MB.

International Society of Surgery (ISS)

Société Internationale de Chirurgie (SIC)

SADI-S TO RYGB DUE TO SEVERE PROTEIN MALNUTRITION, WITH KWASHIORKOR SYNDROME. vilallongapuy@gmail.com