继发于 Roux-en-Y 胃旁路术后肠道吸收不良的眼干症。

GMS ophthalmology cases Pub Date : 2024-01-24 eCollection Date: 2024-01-01 DOI:10.3205/oc000233
José Arturo Oyervides-Alvarado, Schenny Murra-Anton, Ethel Guinto-Arcos, Laura Alejandra González-Dibildox, Nallely Ramos-Betancourt
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引用次数: 0

摘要

简介维生素 A 是一种脂溶性维生素,通过饮食获取。维生素 A 缺乏症是发展中国家儿童因摄入不足而导致可预防性失明的主要原因(Phanachet 等人,2018 年)。然而,在吸收不良占主导地位的发达国家,这种情况并不常见:一位 51 岁的女性前来就诊,主诉异物感、疼痛、流泪、视力波动、夜盲症、腹泻、多食和体重减轻。她曾做过Roux-en-Y胃空肠搭桥术、林奇综合征和右半结肠切除术及回肠结肠吻合术,还提到另外一次不明肠道切除术。在眼科检查中,最佳矫正视力为 20/30,双眼眼压均为 11 毫米汞柱。前段生物显微镜检查显示,患者的结膜干燥、增厚并伴有皱纹,双眼睑结膜间有多个灰白色、圆形、融合性、泡沫状的小病灶,与比托特斑相符,并伴有浅表点状角膜炎:在发达国家,减肥手术、炎症性肠病和终末期肝病的增加导致吸收不良综合征和营养缺乏病例的增加。视黄醇是角膜和结膜上皮细胞分化所必需的物质,缺乏视黄醇会导致多种眼表症状,即所谓的干眼症。在这种情况下,胃旁路手术和另一种不明肠道切除术应引起对吸收不良和营养缺乏的怀疑。然而,维生素 A 缺乏症很容易被忽视:结论:对于患有干眼症的患者,检查应包括既往的胃肠道手术史,尤其是减肥手术已成为一种流行的技术。据我们所知,这是第一例关于林奇综合征患者患有眼干症的病例报告。
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Xerophthalmia secondary to bowel malabsorption after Roux-en-Y gastric bypass.

Introduction: Vitamin A is a fat-soluble vitamin, obtained through diet. Vitamin A deficiency is the leading cause of preventable blindness in children in developing countries due to impaired intake (Phanachet et al. 2018). Nevertheless, it is uncommon in the developed world where malabsorption takes a prominent role.

Case description: A fifty-one-year-old female presented complaining of foreign body sensation, pain, tearing, fluctuating visual acuity, nyctalopia, diarrhea, polyphagia and weight loss. She had history of Roux-en-Y gastro-jejunal bypass, Lynch syndrome and right hemicolectomy with ileo-colonic anastomosis, she also referred to an additional unspecified bowel resection. In the ophthalmologic examination, best corrected visual acuity was 20/30, intraocular pressure was 11 mmHg in both eyes. Anterior segment biomicroscopy revealed a dry and thickened conjunctiva with wrinkles, multiple grey-white small, round, confluent, foamy lesions in the interpalpebral conjunctiva of both eyes, compatible with Bitot's spots, and superficial punctate keratitis.

Discussion: The rise of bariatric surgery, inflammatory bowel disease and end stage liver disease has led to an increase in cases of malabsorption syndrome and nutrient deficiencies in the developed world. Retinoids are essential for corneal and conjunctival epithelial cells differentiation and its deficiency is associated with a wide spectrum of ocular surface manifestations known as xerophthalmia. In this case, a gastric bypass and another unspecified bowel resection should raise the suspicion of malabsorption and nutrient deficiencies. In our patient, the diagnosis was made early and appropriate treatment was implemented before irreversible damage arose, however, vitamin A deficiency can be easily overlooked.

Conclusion: In patients with xerophthalmia, interrogation should include previous history of gastrointestinal surgery, especially since bariatric surgery has become a popular technique. This is, to our knowledge, the first case report of xerophthalmia in a patient with Lynch syndrome.

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