Published online Mar 27, 2018. doi: 10.4254/wjh.v10.i3.396
Peer-review started: December 13, 2017
First decision: January 15, 2018
Revised: January 22, 2018
Accepted: February 7, 2018
Article in press: February 7, 2018
Published online: March 27, 2018
Bariatric surgery is an effective tool in the treatment of patients with morbid obesity. In these case reports we describe 2 patients who developed liver failure after currently-practiced types of bariatric surgery, caused by a prolonged state of malnutrition provoked by psychiatric problems. Despite intensive guidance of a psychologist and dieticians after surgery, our patients deteriorated psychologically, resulting in a prolonged state of severe malnutrition and anorexia. Finally, a state of starvation was reached, passing a critical level of the liver capacity. Patients who present with signs of severe protein malnutrition after bariatric surgery should be closely monitored and checked for nutritional status. Specific attention should be given to patients who develop psychiatric problems post-bariatric surgery. If refeeding does not result in clinical improvement, reversal surgery should be considered in a timely manner.
Core tip: Monitoring of patients after bariatric surgery is important. When psychiatric problems appear, you should be alert and treat your patients proactively. Unfortunately, these case reports show that psychiatric deterioration can lead to severe malnutrition and anorexia, although rarely resulting in liver insufficiency and failure.