Reports of fatty infiltration of the liver following jejunoileal shunt for obesity and hyperlipemia are frequent. Cases of overt liver failure, in contrast, are rare and poorly documented following the various types of small bowel bypass. Fifteen months after jejunoileal bypass, a 41-year-old nonalcoholic woman whose preshunt liver function was chemically normal was found to have morbidly abnormal liver chemistry values. A biopsy examination demonstrated severe fatty metamorphosis bordering on frank cirrhosis. Reversal of her shunt led to return of her liver chemistry values to normal and reversal of the morphologic changes noted at biopsy examination.
Close follow-up of patients subjected to small bowel bypass for obesity or hyperlipemia is mandatory. If liver function abnormalities persist for more than six months, strong consideration should be given to reversal of the shunt.