Bowel bypass syndrome

We report two cases of a syndrome related to the bowel bypass surgical procedure. This syndrome consists of a flu-like illness, with temperatures from 38.3 to 39.4 degrees C (101 to 103 degrees F), chills, malaise, and inflammatory papules and pustules, 2 to 4 mm in diameter, on the extremities and upper part of the trunk. The illness lasts two to six days, and then recurs in one to six weeks. During some episodes, myalgia and polyarthralgia occur; between episodes, joints are normal. In both patients, extensive evaluations had been made to determine the cause of the persistent illness before this distinctive syndrome, related to the bowel bypass surgical procedure, was recognized. These two cases are also illustrative of the two therapeutic approaches that may be of value: administration of antibiotics, esecially 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.