Small intestinal bacterial overgrowth in a patient with blind-loop syndrome.

Abstract

SIBO is a condition in which the small bowel is colonized by excessive aerobic and anaerobic microbes that are normally present in the colon. A 78 years old patient with previous Bilroth II resection due to bleeding peptic ulcer was hospitalized because of diarrhea, fatigue, weight lost and bilateral edemas. Lab tests showed mild normocytic anemia and hypoalbuminemia and the microbiologic stool tests were negative. The gastroscopy showed the gastro-duodenal anastomosis with two fistulous openings and necrotic surface. The histopathology report from the biopsies taken from the region showed only presence of unspecific inflammation. Initially the patient was treated with probiotics, nutritive support, fresh frozen plasma and human albumin but with no remarkable improvement. The treatment with Rifaximin 1200mg/day led to a significant improvement, but because of the anatomic abnormality the patient was referred to surgery after all. Most cases of bacterial overgrowth are successfully treated with antibiotics. However, when the conservative treatment fails and when SIBO is associated with some anatomic abnormality, the surgical treatment may be necessary.