Bowel bypass syndrome

Dicken and Seehofer 1979.

BADAS

A dermatosis with systemic symptoms occurring in obese patients after ileo-jejunal bypass surgery. BADAS is one of the classic neutrophilic dermatoses.

Approximately 20% of all patients who have ileojejunal bypass surgery.

After an artificial short bowel is created, large parts of the small bowel are bypassed.

• Erythematous, coarse papules and pustules localised to the trunk as well as the upper and lower extremities
• Flu-like symptoms, joint symptoms (due to circulating immune complexes and cryoglobulins) cryoglobulinemia, tendinitis
• The disease may be associated with xerosis cutis, erythema nodosum and acrodermatitis enteropathica-like skin lesions

• History (Ileojejunal bypass surgery?)
• Clinical
• Histopathological findings

Suspiciously many neutrophilic granulocytes, papillary oedema, sometimes suggested subepidermal vesicle formation, pustules, necrotising vasculitis.

Spontaneous healing as well as long-term, intermittent courses have been described.

• Re-operation if possible
• Doxycycline p.o. 200 mg 1x tgl. for approx. 3 weeks
• Metronidazole p.o. up to 1.5 g/day
• Low-dose oral glucocorticoids

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