Obesity Surgery

, Volume 19, Issue 8, pp 1176–1179 | Cite as

Brown Bowel Syndrome Secondary to Jejunoileal Bypass: The First Case Report

  • Hwajeong LeeEmail author
  • Arthur M. Carlin
  • Adrian H. Ormsby
  • Min W. Lee
Case Report


A 58-year-old woman with a surgical history of jejunoileal bypass in 1980 for weight reduction sought medical attention with multiple complaints. The patient had not been taking any nutritional supplements since her bypass surgery, 26 years previously. She was found to have osteomalacia, chronic diarrhea, secondary hyperparathyroidism, and hyperoxaluria with a frequent history of nephrolithiasis. Because of her severe osteodystrophy and metabolic complications, reversal of her jejunoileal bypass was recommended. Reversal of the jejunoileal bypass with a sleeve gastrectomy was performed. Laparotomy revealed brown discoloration of the entire alimentary limb with atrophy of the bypassed intestinal limb. Histologic examination of the resected small bowel demonstrated brown pigment deposits within smooth muscle cells of the bowel wall. The pigment stained positive with Fontana-Masson most likely representing lipofuscin. We report a case of brown bowel syndrome complicating jejunoileal bypass, the first case reported in the literature to the best of our knowledge.


Bariatric surgery Malnutrition Jejunoileal bypass Brown bowel syndrome Lipofuscin 



The authors have no commercial associations that might pose a conflict of interest. All authors have made substantive contributions to the study and endorsed the data and conclusions.


  1. 1.
    Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci. 2006;331:219–25.CrossRefGoogle Scholar
  2. 2.
    Alvarez-Leite JI. Nutrient deficiencies secondary to bariatric surgery. Curr Opin Clin Nutr Metab Care. 2004;7:569–75.CrossRefGoogle Scholar
  3. 3.
    Bloomberg RD, Fleishman A, Nalle JE, et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005;15:145–54.CrossRefGoogle Scholar
  4. 4.
    Ruchti C, Eisele S, Kaufmann M. Fatal intestinal pseudo-obstruction in brown bowel syndrome. Arch Pathol Lab Med. 1990;114:76–80.PubMedGoogle Scholar
  5. 5.
    Robinson MHE, Dowling BL, Clark JV, et al. Brown bowel syndrome: an unusual cause of massive dilatation of the colon. Gut. 1989;30:882–4.CrossRefGoogle Scholar
  6. 6.
    Drake WM, Winter TA, Price SK, et al. Small bowel intussusception and brown bowel syndrome in association with severe malnutrition. Am J Gastroenterol. 1996;91:1450–2.PubMedGoogle Scholar
  7. 7.
    Hurley JP, Leary R, Connolly CE, et al. Massive lower gastrointestinal bleeding in association with the brown bowel syndrome. J R Soc Med. 1991;84:437–8.CrossRefGoogle Scholar
  8. 8.
    Linner JH. Bariatric surgery: is it legitimate—or what? Obes Surg. 1992;2:295–301.CrossRefGoogle Scholar
  9. 9.
    Jones KBJ. Bariatric surgery—where do we go from here? Int Surg. 2004;89:51–7.PubMedGoogle Scholar
  10. 10.
    Livingstone EH. Complications of bariatric surgery. Surg Clin North Am. 2005;85:853–68.CrossRefGoogle Scholar
  11. 11.
    Baierlein SA, Wistop A, Looser C, et al. Abdominal actinomycosis: a rare complication after laparoscopic gastric bypass. Obes Surg. 2007;17:1123–6.CrossRefGoogle Scholar
  12. 12.
    Zerey M, Sigmon LB, Kuwada TS, et al. Bleeding duodenal ulcer after roux-en-Y gastric bypass surgery. J Am Osteopath Assoc. 2008;108:25–7.PubMedGoogle Scholar
  13. 13.
    Zainabadi K, Ramanathan R. Intussusception after laparoscopic roux-en-Y gastric bypass. Obes Surg. 2007;17:1619–23.CrossRefGoogle Scholar
  14. 14.
    Campos JM, Siqueira LT, Meira MR, et al. Gastrobronchial fistula as a rare complication of gastroplasty for obesity: a report of two cases. J Bras Pneumol. 2007;33:475–9.CrossRefGoogle Scholar
  15. 15.
    Thaisetthawatkul P, Collazo-Clavell ML, Sarr MG, et al. A controlled study of peripheral neuropathy after bariatric surgery. Neurology. 2004;63:1462–70.CrossRefGoogle Scholar
  16. 16.
    Passaro E Jr, Drenick E, Wilson SE. Bypass enteritis. A new complication of jejunoileal bypass for obesity. Am J Surg. 1976;131:169–74.CrossRefGoogle Scholar
  17. 17.
    Marceau P, Hould FS, Lebel S, et al. Complications of combined gastric restrictive and malabsorptive procedures: part 2. Curr Surg. 2003;60:274–9.CrossRefGoogle Scholar
  18. 18.
    Foster CS. The brown bowel syndrome: a possible smooth muscle mitochondrial myopathy? Histopathology. 1979;3:1–17.CrossRefGoogle Scholar
  19. 19.
    Reynaert H, Debeuckelaere S, De Waele B, et al. The brown bowel syndrome and gastrointestinal adenocarcinoma. Two complications of vitamin E deficiency in celiac sprue and chronic pancreatitis? J Clin Gastroenterol. 1993;16:48–51.CrossRefGoogle Scholar
  20. 20.
    Sciller M, Cohen I, Munichor M, et al. The brown bowel syndrome associated with jejunal carcinoma. Am J Gastroenterol. 1993;88:1788–9.Google Scholar

Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Hwajeong Lee
    • 1
    Email author
  • Arthur M. Carlin
    • 2
  • Adrian H. Ormsby
    • 1
  • Min W. Lee
    • 1
  1. 1.Department of Pathology and Laboratory MedicineHenry Ford HospitalDetroitUSA
  2. 2.Department of SurgeryHenry Ford HospitalDetroitUSA

Personalised recommendations