Kwashiorkor Mimicking Portal Hypertensive Ascites After Bariatric Surgery.

Kwashiorkor is a severe form of protein-calorie malnutrition. It is rarely observed in well-developed countries and is a potential complication of bariatric surgery. We report a case of kwashiorkor presenting as new-onset hepatic steatosis and high serum-ascites albumin gradient, low total protein ascites in an adult 2 years after Roux-en-Y gastric bypass with heavy alcohol use, and pancreatic insufficiency. The ascites resolved with parenteral nutrition, alcohol cessation, and pancreatic enzyme supplementation. This case highlights the diagnostic and pathophysiologic complexity of malnutrition-related liver disease in the bariatric population, especially considering that it can mimic the more commonly encountered portal hypertensive ascites.