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Unusual presentation of more common disease/injury
CASE REPORT
A case of a chronic salmonella infection following Roux-en-Y gastric bypass surgery, treated successfully by a laparoscopic cholecystectomy
  1. Zohaib Siddiqui1,
  2. Zain Ahmed Siddiqui2,
  3. Fahd Husain3,
  4. Midhat Siddiqui4
  1. 1Medical Student, King's College London School of Medical Education, London, UK
  2. 2Foundation Year 1, Queen Elizabeth Hospital, London, UK
  3. 3Foundation Year 2, Darent Valley Hospital, Dartford, UK
  4. 4Upper GI Surgery, Queen Elizabeth Hospital, London, UK
  1. Correspondence to Midhat Siddiqui, midhat.siddiqui{at}nhs.net

Summary

We report a case of chronic infection caused by Salmonella and cured by a laparoscopic cholecystectomy after Roux-en-Y gastric bypass (RYGB) surgery for obesity. This patient presented with a 2-year history of chronic abdominal pain, loose stools and excessive weight loss. Her stool and urine cultures were positive for Salmonella. Despite multiple courses of antibiotics, she remained positive.

After undergoing a laparoscopic cholecystectomy, the patient became asymptomatic and stools remained negative. In chronic carriers for Salmonella, the gall bladder is the common reservoir for the bacteria and removing it is usually curative.

The possibility that the source of the may be in the biliary limb of her bariatric procedure and not in the gall bladder remained a concern.

In patients who have had a RYGB, cholecystectomy is an effective treatment.

All patients presenting with abdominal symptoms following RYGB should have stool and urine cultures taken as part of their work up.

  • gastrointestinal system
  • infection (gastroenterology)
  • obesity (nutrition)
  • gastrointestinal surgery

https://doi.org/10.1136/bcr-2017-219395

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    Footnotes

    • Contributors ZS: collected notes, ensured the consent was obtained, submitted the paper, wrote the case report from the notes and discussed it with the corresponding author and the other two authors, ensured final uploading of the paper to the BMJ and checked the references. ZAS: wrote the summary/background and proof read the case report and did background research on line about the subject matter. FH: wrote the discussion helped by ZAS. MS: provided guidance and proof read the paper.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.