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Spondyloarthropathy After Ampullary Carcinoma Resection: “Post-Whipple” Disease

Bhangle, Samir D. MD*; Kramer, Neil MD†‡; Rosenstein, Elliot D. MD†‡

JCR: Journal of Clinical Rheumatology: August 2009 - Volume 15 - Issue 5 - p 241-243
doi: 10.1097/RHU.0b013e3181b08f31
Case Report

The development of bowel-bypass syndrome complicating the Whipple procedure for biliary tract carcinoma is described here for the first time. A 56-year-old HLA-B27 + man, treated with excision of adenocarcinoma of the ampulla of Vater, developed an undifferentiated spondyloarthropathy, initially unresponsive to nonsteroidal anti-inflammatory drugs and doxycycline, but eventually controlled with sulfasalazine and tapered corticosteroids. This condition represents another example of a rheumatic syndrome occurring after disruption of gastrointestinal tract continuity and likely development of small bowel bacterial overgrowth.

This 56 year old HLA B27 positive man developed back pain and oligoarthritis after a Whipple surgical procedure that may have created a blind loop.

From the *Department of Medicine, Saint Barnabas Medical Center, Livingston, New Jersey; †Division of Rheumatology, Saint Barnabas Medical Center, Livingston, New Jersey; and ‡the Center for Rheumatic and Autoimmune Diseases, Livingston, New Jersey.

Correspondence: Elliot D. Rosenstein, MD, Center for Rheumatic and Autoimmune Diseases, 200 South Orange Ave, Livingston, New Jersey 07039. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.