Background

Gastric bypass with billroth II reconstruction plus braun anastomosis is an effective treatment for diabetes and obesity. However, the procedure is invasive and often prone to severe postoperative complication. We describe a cases of persistent vomiting and severe mal-nutrition (BMI 19.5) as a result of extreme distalization of the braun anastomosis. Method: A 28 years old female underwent revision surgery for severe malnutrition as a result of a bilroth II gastric bypass with braun anastomosis. The revision involved the take-down of the Braun anastomosis and the placement of trans-nasal feeding tube. Before the revision, the patient was fed parenterally for 10 days. Results: Operative findings were severe intra-abdominal adhesion and the braun anastomosis constructed between the afferent and efferenet limb at 20 cm and 50 cm distal to the gastrointestinal anastomosis and proximal to the ileoceecal junction respectively. The afferent limb was 220cm while the efferent limb was 270 cm. Following adhesiolysis and take-down of the braun anastomosis, the patient had prompt return of bowel function without recurrence of vomiting. The patient was discharge three day following the revision surgery with a significantly improved nutritional status (Albumin: 22.1, HGB:) the overall hospital stay was 16 days. Conclusions: Malnutrition induced by the extreme distalization of the braun anastomosis was successfully reverted by deconstructing the braun anastomosis