Bariatric Surgery for a Medical Complex Condition
Manuel Fortun Landecho 1 , Edurne Iñigo-Morrás 2 , Victor Valenti 3 4 5
We present the case of a 57-year-old morbidly obese male, with Barrett’s esophagus due to chronic gastro-esophageal reflux disease. He also had severe limb-girdle muscular dystrophy (LGMD) that made him unable to walk and a body weight of 122.6 kg (BMI 41.4 kg/m2), despite several failed dietary programs. He complained of muscle pain, inability to attain the orthostatic position, and step climbing problems, experienced since the age of 45.
The diagnosis of a LGMD was based on electromyography, and a muscle biopsy, that showed an intense atrophy of muscle fibers and a collagenic fibrosis, fat infiltration, and an increased number of necrotic muscular fibers. In addition, there were features of regeneration. Immunohistochemical analysis revealed a predominace of type 1 and 2 fibers. No immunoactivity against C cytochrome-oxidase was found.
The result of the inmunohistoanalyses against dystrophins and spectrin was inconclusive due to the insufficient amount of material harvested in the biopsy. The patient also presented a family history of LGMD, with two brothers with the same disorder, as well as his mother and three of her eight brothers.