Colonic pseudo-obstruction: a late complication of jejunoileal bypass

Three cases of jejunoileal bypass, performed for morbid obesity, were complicated 3 to 4 years later by symptoms of colonic pseudo-obstruction. In each case the colon was enlarged, dilated and atonic with no demonstrable organic obstruction. In the patient with end-to-side anastomosis, the entire colon was dilated. In the two patients with end-to-end anastomosis, the dilatation affected the colon distal to the anastomosis with the defunctionalized small bowel. Treatment with antianaerobic antibiotics resulted in a dramatic disappearance of symptoms. It is suggested that bacterial overgrowth in the defunctionalized loops of small bowel may play an important role in the development of colonic pseudo-obstruction as a late complication of jejunoileal bypass.