Bowel bypass syndrome
Last Updated: 2020-08-12
Dicken und Seehofer 1979.
Dermatosis with systemic symptoms in obese patients after an ileo-jejunal bypass operation. BADAS is one of the classic neutrophilic dermatoses.
In about 20% of all patients undergoing ileo-jejunal bypass surgery.
After the creation of an artificial short intestine, large parts of the small intestine are bypassed.
- Erythematous, coarse papules and pustules, which are located on the trunk as well as on the upper and lower extremities
- Flu-like symptoms, joint complaints (due to circulating immune complexes and cryoglobulins) cryoglobulinemia, tendinitis
- The disease can be associated with xerosis cutis, erythema nodosum and acrodermatitis-enteropathica-like skin changes
- Medical history (Ileo-jejunale bypass operation?)
- Clinical features
- Histopathological findings
Noticeably many neutrophil granulocytes, papillary edema, sometimes indicated subepidermal vesicle formation, pustules, necrotising vasculitis.
Both spontaneous healings and long-term, intermittent courses are described.
- Re-operation where possible
- Doxycycline p.o. 200 mg 1x daily for about 3 weeks
- Metronidazole p.o. up to 1,5 g/day
- Low-dose oral glucocorticoids
- Ahmed AR , Drenick E. Cutaneous immunofluorescence studies in bowel bypass syndrome. Clin Exp Dermatol 1982;7:477-83.
- Dicken CH. Bowel-associated dermatosis-arthritis syndrome: bowel bypass syndrome without bowel bypass. Mayo Clin Proc 1984;59:43-6.
- Ely PH. The bowel bypass syndrome: a response to bacterial peptidoglycans. J Am Acad Dermatol 1980;2:473-87.
- Geary RJ, Long LL , Mutasim DF. Bowel bypass syndrome without bowel bypass. Cutis 1999;63:17-20.
- Simon SI, Sikka JV , Lynfield YL. Bowel bypass syndrome. Cutis 1981;28:545-7, 50, 79.
- Tu J, Chan JJ , Yu LL. Bowel bypass syndrome/bowel-associated dermatosis arthritis syndrome post laparoscopic gastric bypass surgery. Australas J Dermatol 2011;52:e5-7.
- Varma JR, Pye J , Sinha A. Dermal complication of the bowel bypass syndrome: a case report. J Fam Pract 1993;36:564-6.