Persistent Hypocalcemia Following Scopinaro Biliopancreatic Diversion: A Case Report

Bariatric surgery is a treatment for morbid obesity and related comorbidities; however, it carries risks of long-term nutritional deficiencies. Among the malabsorptive procedures, the Scopinaro biliopancreatic diversion (BPD) achieves durable weight loss but is associated with significant metabolic and nutritional complications, particularly those involving calcium, iron, and fat-soluble vitamins. This case report highlights a patient who developed severe, chronic hypocalcemia after undergoing Scopinaro BPD and ultimately required surgical conversion to a Roux-en-Y gastric bypass (RYGB) for resolution of his symptoms. We present the case of a 50-year-old male with a history of morbid obesity who initially underwent gastric banding, followed years later by a Scopinaro BPD. Since the latter surgery, he experienced recurrent severe hypocalcemia, vitamin D deficiency, and iron-deficiency anemia, requiring repeated hospitalizations for intravenous calcium supplementation, iron therapy, and blood transfusions, despite strict adherence to oral supplementation. Five years after the procedure, he first presented with symptomatic anemia (hemoglobin, or Hgb 7 g/dL), managed with transfusion and iron therapy. Over the following decade, he experienced multiple similar admissions, including one with profound hypocalcemia (1.1 mmol/L), accompanied by dizziness, limb stiffness, and paresthesia. Workup for systemic causes, including hypoparathyroidism, was negative, and chronic malabsorption was determined to be the underlying etiology. After optimization of electrolytes and Hgb levels, the patient underwent laparoscopic takedown of the Scopinaro anastomosis with conversion to an RYGB. The surgery was completed without complication. Postoperatively, his calcium and Hgb improved steadily, reaching 1.9 mmol/L and 12 g/dL, respectively, at three months' follow-up. He remained asymptomatic and demonstrated weight regain, with significant improvement in quality of life. In our case, persistent hypocalcemia and anemia refractory to conservative treatment were successfully managed by conversion to RYGB, which restored absorptive capacity while maintaining a balance of weight control and improved nutritional status. This highlights the critical role of surgical revision in managing long-term metabolic complications of highly malabsorptive procedures.