PubMed · 14145332
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C WELLS. 1964. VALEDICTORY.. https://pubmed.ncbi.nlm.nih.gov/14145332/
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HISTORY: A 64-year old somnolent man was admitted to the emergency department with a reported seizure half an hour earlier. Due to similar episodes the patient had been treated with antiepileptics in the past. The patient s past history revealed a partial gastrectomy (Billroth II) more than ten years ago. DIAGNOSTIC FINDINGS AND THERAPY: At the time of admission blood glucose was 31 mg/dl. Other routine laboratory analyses and the clinical examination were normal. In addition, a detailed neurological examination and a cranial CT-scan were normal. Due to the hypoglycemia a dumping syndrome was suspected. A three hour oral glucose tolerance test (OGTT) resulted in a late hypoglycemia, establishing the diagnosis of late dumping. After adaptation of the patient's diet no further hypoglycemic episodes occurred. CONCLUSION: Manifestation of a dumping syndrome may occur even years after gastrectomy. Therefore, in patients presenting with hypoglycemia and a history of gut surgery, a dumping syndrome should be suspected. Furthermore, seizures due to hypoglycemia may be the only manifestation of late dumping.
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Complete or partial removal of the stomach results in considerable anatomical and physiological changes, which, in turn lead to more or less pronounced dietary problems. For this reason, patients should receive comprehensive postoperative counseling. In the majority of cases, the major problems can be avoided or symptoms ameliorated. The selection of suitable foods must be discussed, as also the particular importance of drinking. Preprandial exercise to stimulate the appetite is just as important as postprandial resting to avoid diarrhea and the dumping syndrome. A central aspect is the distribution of the food ingested over six to ten small portions. Some nutrients may need to be substituted--for example, vitamin B12, the fat-soluble vitamins, calcium and iron. With increasing time after the operation, alimentation problems usually abate, but in the individual case may persist for years.