Refractory diffuse bony pain 20 years after jejunoileal bypass
| Autor: | Herng-Sheng Lee, Shih-Hua Lin, Liang-Kuang Diang, Chih-Chien Sung |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Male
medicine.medical_specialty Chest Pain medicine.medical_treatment Biopsy Jejunoileal bypass chemistry.chemical_element Calcium Technetium Tc 99m Medronate Gastroenterology Hypomagnesemia Excretion Diagnosis Differential Ilium Jejunoileal Bypass Shoulder Pain Internal medicine medicine Humans Radionuclide Imaging Postoperative Care Osteomalacia Pain Postoperative Hip business.industry Osteoid General Medicine Middle Aged medicine.disease Urinary calcium Surgery chemistry business Hypophosphatemia |
| Zdroj: | Southern medical journal. 103(6) |
| ISSN: | 1541-8243 |
| Popis: | Osteomalacia can be a late but unrecognized complication following jejunoileal bypass. We describe a 53-year-old man who underwent jejunoileal bypass for morbid obesity twenty years earlier who suffered from progressive diffuse bony pain refractory to nonsteroidal anti-inflammatory drugs. He was initially diagnosed with a malignancy with bone metastasis. However, pertinent laboratory data were notable for hypocalcemia (7.5 mg/dL, albumin 4.1 mg/dL) with low urinary calcium excretion (14 mg/day), hypophosphatemia (2.0 mg/dL) with low urinary phosphate excretion (53 mg/day), hypomagnesemia (1.5 mg/dL) with low urine magnesium excretion (23 mg/day), low 1, 25 (OH)2 vitamin D3, and elevated serum alkaline phosphatase and intact parathyroid hormone (iPTH). These laboratory findings pointed to a defect in calcium, phosphate, and magnesium handling in the gastrointestinal tract. Bone biopsy of the iliac crest clearly demonstrated typical changes of osteomalacia with excessive osteoid accumulation and reduced mineralization. His clinical symptoms were refractory to oral 1, 25 (OH)2 vitamin D3 and calcium supplementation but significantly improved with the addition of intermittent intravenous active 1, 25 (OH)2 vitamin D3, calcium, phosphate, and magnesium supplementation. Osteomalacia is an easily misdiagnosed late complication of jejunoileal bypass. Early recognition can avoid circuitous diagnosis and inappropriate management. |
| Databáze: | OpenAIRE |
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