Journal of Pediatric Surgery Case Reports (Apr 2019)

Resolution of refractory iron deficiency anemia following sleeve gastrectomy in an adolescent with severe obesity

  • S. Christopher Derderian,
  • Louis Le,
  • Stavra A. Xanthakos,
  • Thomas H. Inge

Journal volume & issue
Vol. 43
pp. 1 – 4

Abstract

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Current surgical options for the management of adolescent obesity include Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG), with recent trends favoring VSG. While both operations result in similar weight reduction, baseline micronutrient status may influence the choice of the procedure in youth. We describe an adolescent with severe obesity, iron deficiency, poor iron absorption, and their impact on decision-making for surgical treatment of her severe obesity. We present a case of a 15-year-old female with a BMI of 50 kg/m2 who was referred for bariatric surgery requesting a RYGB. During her preoperative evaluation, mild iron deficiency anemia was identified after noting a low hemoglobin concentration and mean corpuscular volume. Endoscopic biopsy revealed mild chronic gastritis. Iron supplementation over a 9-month period did not improve her anemia preoperatively and an oral iron challenge demonstrated inadequate absorption. A VSG was recommended to reduce further nutritional risk. Four months following surgery, her anemia resolved, and iron indices normalized while on supplemental micronutrients. Weight loss and hematologic status remained stable over the ensuing eight years of follow-up. Given the risks of micronutrient deficiency following bariatric surgery, particularly RYGB, preoperative evaluation of iron status among patients with microcytic anemia and anticipated nutritional risks of available surgical procedures should influence decision-making during surgical management. Keywords: Bariatric surgery, Obesity, Laparoscopic sleeve gastrectomy, Vertical sleeve gastrectomy, Iron deficiency anemia, Adolescent