Ehlers-Danlos syndrome is a hereditary connective tissue disorder that has gastrointestinal manifestations in over 50% of its cases. We present the first case of
bariatric surgery in a patient with
Ehlers-Danlos syndrome and outline management challenges in the context of the relevant literature. A 56-year-old man with
type IV Ehlers-Danlos syndrome and a body mass index of 41.8 kg/m2 was referred to the bariatric centre of the Churchill Hospital, Oxford, for consideration of surgery for
morbid obesity. His comorbidity included
type 2 diabetes,
hypertension, dyslipidaemia and obstructive sleep apnoea. He underwent a laparoscopic
Roux-en-Y gastric bypass. His initial recovery was uneventful and he was discharged on the first postoperative day. Six weeks later, he presented with 43.9% excess
weight loss and improved glycaemic control. Three months postoperatively, however, he complained of
dysphagia, regurgitation and postprandial
pain. A
barium meal and gastroscopy suggested the presence of a
gastric diverticulum. A surgical exploration was planned. Intraoperative gastroscopy demonstrated an asymmetrical gastric pouch dilatation and the pouch was therefore refashioned laparoscopically. Despite the initial symptomatic relief, two months later he experienced retrosternal
pain with progressive
dysphagia. Since then, multiple endoscopic dilatations of the gastro-oesophageal junction have been performed for recurrence of symptoms. Finally, a laparoscopic
hiatus hernia repair and adhesiolysis was performed resulting in complete relief of patient's symptoms. Bariatric management of patients with
Ehlers-Danlos syndrome can prove challenging. The bariatric team must implement a careful management plan including a detailed consent process, a tailored surgical intervention and a follow-up focused on potential gastrointestinal manifestations.