Evolution of liver disease in morbid obesity after small-intestinal bypass and its restoration. A case report

We studied a woman who underwent a jejunoileal bypass for the treatment of morbid obesity and in whom severe jaundice and hepatic failure developed six months later; these developments prompted restoration of the normal continuity of the small bowel. Four serial wedge biopsy specimens of the liver were taken during a three-year follow-up. The first biopsy was performed before the bypass surgery, the second six months after the operation, the third three months after restoration of normal continuity of the bowel, and the fourth three years later. The biopsy specimens clearly showed the morphologic changes of the liver in obesity, the effect of small intestinal bypass and its reversal on hepatic structure, and the natural evolution of liver disease in morbid obesity.