Journal
AMERICAN SURGEON
Volume 87, Issue 4, Pages 576-580Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/0003134820952427
Keywords
stomach intestinal pylorus-sparing bariatric surgery; hypocalcemia; Roux-en-Y; gastric bypass
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Certain types of bariatric surgery can lead to calcium malabsorption in patients, with the parathyroid hormone (PTH) axis playing a crucial role in maintaining normocalcemia. This case study highlights a patient who developed refractory hypocalcemia following previous stomach intestinal pylorus-sparing bariatric surgery, ultimately requiring surgical intervention to successfully improve blood calcium levels and treat the condition.
Some forms of bariatric surgery make patients susceptible to calcium malabsorption, and the parathyroid hormone (PTH) axis is important for maintaining normocalcemia in these patients. Injury to the parathyroid glands due to anterior neck surgery commonly causes PTH axis disruption and can result in severe hypocalcemia in bariatric surgery patients. Herein, we present a case of a patient with a history of stomach intestinal pylorus-sparing bariatric surgery who developed refractory hypocalcemia requiring daily intravenous (IV) calcium 2 years after thyroidectomy. PTH levels were inappropriately normal during episodes of hypocalcemia, and urinary calcium level was <3.0 mg/dL following large oral doses of calcium, suggesting that both inadequate PTH response and malabsorption contributed to her severe hypocalcemia. In order to enhance calcium absorptive capacity while minimizing the risk of weight regain, she was surgically treated with a Roux-en-Y gastric bypass proximal to the prior operation. The surgery successfully improved blood calcium levels; the patient was successfully weaned from IV calcium and was able to maintain normocalcemia with oral supplements. We discuss the case in the context of available literature and provide our recommendations.
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