2010 Volume 46 Issue 5 Pages 857-861
A 7-year-old boy with short bowel syndrome was admitted because of severe anemia. He had a history of undergoing massive bowel resection in the neonatal period. Only 70cm of the jejunum without an ileocaecal valve remained. He showed breathlessness and general fatigue 4 years (at the age of 7 years) after weaning off parenteral nutrition. His Hb was 6g/dl, and MCV was 111 fl. His serum vitamin B_<12> (VB_<12>) level was 71pg/ml. Diagnosis of megaloblastic anemia (MA) was made, and VB_<12> was intravenously administered. In the English and Japanese literature, 12 patients including our case who had developed MA after a surgery were found. Mean time between the surgery and presentation was 9 years. The causes of MA were malabsorption in 8 patients, bacterial overgrowth in 3, and discard of gastric juice (loss of intrinsic factor) in 1. It should be kept in mind that MA needs many years to develop clinical symptoms after surgery, and that various possible causes for MA were observed even after surgery.
