LB044 - REVERSAL OF ACUTE LIVER FAILURE POST-ROUX-EN-Y- GASTRIC BYPASS WITH TOTAL PARENTERAL NUTRITION

LB044

REVERSAL OF ACUTE LIVER FAILURE POST-ROUX-EN-Y- GASTRIC BYPASS WITH TOTAL PARENTERAL NUTRITION

C. Daou^1,*, J. S. Barajas-Gamboa¹, A. Shatnawei¹, S. Abdal Raheem¹

¹Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi , United Arab Emirates

Rationale: Acute liver failure (ALF) is a rare but life-threatening complication following Roux-en-Y gastric bypass (RYGB). Total parenteral nutrition (TPN) has been employed in reversing metabolic insults contributing to hepatic failure, yet its application in post-bariatric ALF remains underreported. This case highlights the reversal of ALF post-RYGB through TPN

Methods: A 39-year-old female with history of chronic pancreatitis, Hepatitis A infection and metabolic dysfunction-associated steatohepatitis, post sleeve gastrectomy in 2015 followed by RYGB in 2019, presented with abdominal pain, nausea, vomiting, steatorrhea and jaundice requiring transplant evaluation. Patient denies alcohol intake. Upon admission, weight was 58kg (BMI=25kg/m²) after 24% weight loss over 6 months (previous BMI=32kg/m²). Laboratory findings: Aspartate Aminotransferase (AST) 66U/L, Alanine Transaminase (ALT) 36U/L, bilirubin 326μmol/L, albumin 28g/L, pre-albumin <0.03 g/L, International Normalised Ratio (INR) 2.5, negative genetic liver disease panel, vitamin deficiencies (A: 0.11μmol/L, D: 17nmol/L). Imaging showed patent vasculature, mild ascites, severe hepatic steatosis with Fibrosis(F3) and Steatosis(S3) on Fibroscan. Patient commenced pancreatic enzyme and TPN 3 days post-admission, continuing at home for additional 5 months

Results: After 5.5 months on TPN, patient gained 8kg (66kg, BMI=28kg/m²) with significant improvement in laboratory results: AST 27U/L, ALT 11U/L, bilirubin 8μmol/L, albumin 30g/L, pre-albumin 0.11g/L, INR 1.2, vitamins (A 0.66μmol/L, D 110nmol/L). Follow-up imaging and fibroscan showed resolution of ascites, improvement in steatosis (S2) and complete resolution of fibrosis (F0). Gastrointestinal symptoms resolved. The patient was then removed from transplant list and weaned off TPN

Conclusion: This case demonstrates that TPN can successfully reverse ALF in post-RYGB patients with malnutrition and malabsorption

Disclosure of Interest: None declared