Hypocupremia-related myeloneuropathy following gastrojejunal bypass surgery

Gastrojejunal bypass surgery may be complicated by nutritional deficiencies, including trace elements. Copper, which is absorbed in the duodenum and proximal jejunum, is poorly absorbed when a significant portion of the proximal small intestine is bypassed. However, despite this theoretical risk of hypocupremia in the gastrojejunal bypass patient, reports of symptomatic copper deficiency are very rare, and even then the deficiency is often potentiated by an accelerant, such as concomitant zinc ingestion. We report a case of hypocupremia resulting in hematologic abnormalities and myeloneuropathy after gastrojejunal bypass surgery for morbid obesity. It stresses the importance of recognizing nutritional deficiencies, particularly copper deficiency, because of the possible and serious sequelae of bone marrow suppression and myeloneuropathy. The early recognition and treatment of the symptoms of hypocupremia is emphasized to avoid these long-term sequelae. With the rapidly growing number of patients undergoing gastrojejunal bypass surgery for morbid obesity, the index of suspicion for hypocupremia must be heightened.