August 28, 1981

Granulomatous Hepatitis Associated With Jejunoileal Bypass Surgery

Author Affiliations

From the Department of Internal Medicine (Dr Kalat), and the Infectious Diseases Section (Dr Martin), Munson Medical Center, Traverse City, Mich.

JAMA. 1981;246(9):982. doi:10.1001/jama.1981.03320090044028

GRANULOMATOUS hepatitis is an uncommon form of liver pathology. It has been described as occurring after jejunoileal bypass surgery. Some of these patients had tuberculosis. In other bypass patients with hepatic granulomas, neither a diagnosis of tuberculosis nor of sarcoidosis was proved, and the cause of the granulomas was obscure.1,2

We report the case of an intestinal bypass patient in whom granulomata developed and who then underwent reanastomosis of her intestinal tract with resolution of the granulomas without antituberculous therapy.

Report of a Case  A 28-year-old woman weighing 127.2 kg underwent jejunoileal bypass surgery. She was hospitalized six months later with nausea, vomiting, weakness, dizziness, and depression. Liver enzyme level abnormalities were present, and a liver biopsy specimen showed extensive fatty metamorphosis.Eighteen months later she weighed 55.4 kg and complained of undesired weight loss, night sweats, shaking chills, easy fatigue, and diarrhea. Physical examination uncovered hepatosplenomegaly but no