# Reversal of Acute Liver Injury Post–Roux-en-Y Gastric Bypass With Total Parenteral Nutrition

## TL;DR

A patient's severe liver injury after gastric bypass surgery improved with long-term nutritional support, avoiding the need for a liver transplant.

## Contribution

Demonstrates that total parenteral nutrition can reverse acute liver injury caused by malnutrition after bariatric surgery.

## Key findings

- Total parenteral nutrition led to weight gain and normalization of liver function tests and vitamin levels.
- Steatosis and fibrosis were reversed, eliminating the need for a liver transplant.
- The case emphasizes the importance of nutritional support post-bariatric surgery.

## Abstract

Acute liver injury is a rare yet serious complication of bariatric surgery, particularly Roux-en-Y gastric bypass. We report the case of a 39-year-old woman with a history of hepatitis A and metabolic dysfunction–associated steatotic liver disease who developed acute liver injury after significant weight loss and malnutrition post–Roux-en-Y gastric bypass. On admission, she presented with steatorrhea, jaundice, and severe hepatic dysfunction. Investigations revealed vitamin A and D deficiencies, steatosis, fibrosis (F3), and severe malabsorption. Total parenteral nutrition was initiated 3 days postadmission and continued for 5.5 months. The patient achieved 8kg weight gain, normalization of liver function tests and vitamin levels, and reversal of steatosis and fibrosis (F0/S2 on repeat Fibroscan). Clinically, her symptoms resolved, and she no longer required a liver transplant. This case highlights the potential of early, sustained total parenteral nutrition in reversing acute liver injury secondary to malnutrition and underscores the importance of comprehensive nutritional support postbariatric surgery.