A 47-year-old man, referred to us from the Rehabilitation Department in February 2011, for assessment of his obesity. The patient had a personal history of spinal cord injury following an accident at work in 2004, with vertebral fracture and incomplete paraplegia at L1. He smoked more than 20 cigarettes a day and had arterial hypertension treated with enalapril 20/hydrochlorothiazide 12.5 every 24 hours and untreated hypertriglyceridaemia.
In the directed anamnesis, he reported great difficulty in daily life (he needs a wheelchair to get around and uses a standing position for transfers). She recognised that she had a strong appetite and snacking between meals. Since 2006 she had tried several times to lose weight, without success. On examination she weighed 135 kg and was 1.72 cm tall, BMI 46.62 kg/m2. tA 145/92. His blood tests showed cholesterol 222 mg/dL and triglycerides 260 mg/dL with HDL cholesterol 41 mg/dL.
After being assessed by the multidisciplinary team at our hospital, and ruling out contraindications for surgery, his case was approved and he underwent laparoscopic Roux-en-Y gastric bypass in January 2014.
One month after surgery the patient is doing well, had no complications in the immediate postoperative period; and denies vomiting at present. He has less appetite and is on a fractional liquid diet. His current weight is 120 kg. From the point of view of her cormobilities, she has stopped hypotensive treatment and her BP control at home is optimal (110/90). Analytically, she has no vitamin deficiency, with daily supplementation of a vitamin complex.