Abstract We report two cases in which necrotizing vasculitis with tenosynovitis arthralgia/arthritis syndrome developed after intestinal bypass surgery. Each of these patients had jejunoileostomies, and the excluded segment was placed in an ilealcolonic anastomosis. We speculate that since the attachment of the excluded segment to the large intestine predisposes it to increased bowel overgrowth of bacteria, these bacteria or their debris may have served as antigens for circulating immune complexes, which were detected in both patients by one or more techniques. Patients who have had an end-to-side anastomosis may be less predisposed to the more severe vasculitis syndrome because there is less likelihood of bacterial overgrowth in the bypassed intestinal segment. (Arch Dermatol 115:725-727, 1979) References 1. Kremen AJ, Linner JH, Nelson C: An experimental evaluation of the nutritional importance of proximal and distal small intestine . Ann Surg 140:439-448, 1954.Crossref 2. Payne JH, DeWind LT, Commons RR: Metabolic observations in patients with jejunocolic shunts . Am J Surg 106:273-289, 1963.Crossref 3. Payne JH, DeWind LT: Surgical treatment of obesity . Am J Surg 118:141-147, 1969.Crossref 4. Scott HW Jr, Sandstead HH, Brill AB, et al: Experience with a new technique of intestinal bypass in the treatment of morbid obesity . Ann Surg 174:560-572, 1971.Crossref 5. Daugharty H, Gogel R: Platelet aggregation by hepatitis B surface antigen-antibody complexes . Infect Immun 14:752-758, 1976. 6. Casey HL, Kokko UP, Schubert JH, et al: Standardized Diagnostic Complement Fixation Method and Adaptation to Micro Test, monograph 74, publication 1228. Laboratory Branch Task Force, Government Printing Office, 1965. 7. Bray GA, Barry RD, Benefield JR, et al: Intestinal bypass operation as a treatment for obesity . Ann Intern Med 85:97-109, 1976.Crossref 8. Campbell JM, Hunt TK, Karam JH, et al: Jejunoileal bypass as a treatment for morbid obesity . Arch Intern Med 137:602-610, 1977.Crossref 9. Bendezu F, Wieland RG, Green SG, et al: Certain metabolic consequences of jejunoileal bypass . Am J Clin Nutr 29:366-370, 1976. 10. Harmon JW, Aliapoulos M, Braasch JW: The excluded small-bowel segment . Arch Surg 111:953-954, 1976.Crossref 11. Shagrin JW, Frame B, Duncan H: Polyarthritis in obese patients with intestinal bypass . Ann Intern Med 75:377-380, 1971.Crossref 12. Hess RJ: Polyarthritis after small-bowel bypass . J Okla, State Med Assoc 67:283-285, 1971. 13. Buchanan RF, Willkens R: Arthritis after jejunoileostomy . Arthritis Rheum 15:644-645, 1971.Crossref 14. Duncan H: Arthropathy and the intestinal bypass operation for intractable obesity . J Rheumatol 4:115-117, 1977. 15. Rose E, Espinoza LR, Osterland CK: Intestinal bypass arthritis: Association with circulating immune complexes and HLA-B27 . J Rheumatol 4:129-134, 1977. 16. Fernandez-Herlihy L: Arthritis after jejunoileostomy for intractable obesity . J Rheumatol 4:125-128, 1977. 17. Wands JR, LaMont JT, Mann E, et al: Arthritis associated with intestinal-bypass procedure for morbid obesity . N Engl J Med 294:121-124, 1977.Crossref 18. Dickson JR, Aoyama DT, Willkens RF: Arthritis and dermatitis following intestinal bypass for obesity . Read before the International Congress of Rheumatology, San Francisco, June 28, 1977 . 19. Mezey E, Imbembo AL, Potter JJ, et al: Endogenous ethanol production and hepatic disease following jejunoileal bypass for morbid obesity . Am J Clin Nutr 28:1277-1283, 1975. 20. O'Leary JP, Maher JW, Hillenbeck JI, et al: Pathogenesis of hepatic failure after obesity bypass . Surg Forum 25:356-359, 1974. 21. Drenick EJ, Ament ME, Finegold SM, et al: Bypass enteropathy; intestinal and systemic manifestations following small-bowel bypass. JAMA 236:269-272, 1976.Crossref 22. Moake JL, Kageler WV, Cimo PL, et al: Intravascular hemolysis thrombocytopenia, leukopenia and circulating immune complexes after jejunal-ileal bypass surgery . Ann Intern Med 86:576-578, 1977.Crossref 23. Soothill JR: Chairman's summary of detection and measurement of circulating soluble immune complexes . Ann Rheum Dis 36( (suppl) ):64-66, 1977.
Archives of Dermatology – American Medical Association
Published: Jun 1, 1979
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