Bowel bypass syndrome

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Abstract
Cases [2] of a syndrome related to the bowel bypass [treatment of morbid obesity] surgical procedure are reported. This syndrome consists of a flu-like illness, with temperatures from 38.3 to 39.4.degree. C, chills, malaise, and inflammatory papules and pustules, 2-4 mm in diameter, on the extremities and upper part of the trunk. The illness lasts 2-6 days, and then recurs in 1-6 wk. During some episodes, myalgia and polyarthralgia occur; between episodes, joints are normal. In both patients, extensive evaluations were made to determine the cause of the persistent illness before this distinctive syndrome, related to the bowel bypass surgical procedure, was recognized. These 2 cases are also illustrative of the 2 therapeutic approaches that may be of value: administration of antibiotics, especially metronidazole, or reconstitution of the normal bowel anatomy. The relationship of this syndrome to the arthritis associated with bowel bypass and to bypass enteropathy is discussed.