Death from hepatic failure after jejunoileal anastomosis

Severe liver dysfunction and even death from hepatic failure after jejunocolic anastomosis has led to the virtual abandonment of that procedure for the surgical treatment of massive obesity. This complication after the currently employed jejunoileal anastomosis has rarely been described before. We present two cases of hepatic necrosis and death after end to side jejunoileal anastomosis and compare the clinical data and liver function test results in these two patients with findings in 124 other patients who underwent a similar procedure for treatment of morbid obesity. No significant differences could be found that would allow early identification of those patients in whom massive hepatic necrosis was developing. Careful follow-up study and perhaps repeated liver biopsy may be necessary to monitor the hepatic status after jejunoileal anastomosis so that reanastomosis can be undertaken at a time when the damage may be reversible.