Rapidly evolving liver decompensation with some remarkable features 14 years after biliopancreatic derivation: a case report and literature review.

Because of the rising incidence of obesity the use of bariatric surgery is also increasing. For the obese it is the only treatment with a proven long-term benefit on weight, comorbidities including non alcoholic steatohepatitis, and long-term mortality. There are, however, several reports on hepatic complications after bariatric surgery leading to malabsorption. The risk of liver decompensation or cirrhosis is one of the reasons jejunoileal bypass has been abandoned. Hepatic complications following Roux-en-Y gastric bypass and biliopancreatic derivation (BPD) are also reported but never beyond 2 years of follow-up. There is only one confirmed case of development of cirrhosis following BPD which presented 10 months after surgery. We present a case of a 39-year-old patient who developed rapidly evolving, and ultimately fatal, liver decompensation in previously unknown cirrhosis, 14 years after BPD. This is the first report of a severe hepatic complication such a long time after a BPD. Existing literature on hepatic complications after bariatric surgery is discussed as are 2 coincidental findings of pronounced ductular reaction on histology and autoimmune haemolytic anaemia.