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[Dumping syndrome in a child with an incorrectly positioned gastrostomy catheter]
I A Zonnenberg1, F H J M van der Staak, M P J M Cuppen
1Universitair Medisch Centrum St Radboud, afd. Kinderchirurgie, Postbus 9101, 6500 HB Nijmegen.
Insights
A pediatric patient
Area of Science:
- Pediatric Gastroenterology
- Surgical Complications
- Metabolic Disorders
Background:
- A 13-month-old girl with a history of congenital posterolateral diaphragm defect.
- Previous surgical history includes Nissen fundoplication and gastrostomy at 1.5 months of age.
- Patient presented with an epileptic seizure attributed to hypoglycemia.
Observation:
- The gastrostomy catheter's tip was identified in the duodenal bulb.
- Repositioning the catheter led to a significant clinical improvement.
- Symptoms were consistent with dumping syndrome, a known complication of Nissen fundoplication in children.
Findings:
- Gastrostomy tube malpositioning can precipitate symptoms of dumping syndrome.
- Dumping syndrome in pediatric patients is often linked to Nissen fundoplication.
- Hypoglycemia-induced seizures can be a manifestation of severe gastrointestinal dysfunction.
Implications:
- Accurate placement and regular checks of feeding tubes are crucial in pediatric patients.
- Considering gastrostomy tube position is essential in diagnosing and managing suspected dumping syndrome.
- Early identification and correction of tube malposition can prevent serious complications like seizures.
Abstract:
A 13-month-old girl experienced an epileptic fit due to hypoglycaemia. She was born with a posterolateral diaphragm defect and at the age of 1.5 months had undergone a Nissen fundoplication with which a gastrostomy was also performed. The tip of the gastrostomy catheter was found to be lying in the bulbus duodeni. Once this had been pulled back, the patient made a good recovery. Dumping syndrome is usually the result of a quicker gastric emptying time or a smaller gastric capacity, and in children it is mostly due to a Nissen fundoplication. In patients fed by tube who exhibit symptoms of dumping syndrome, the position of the feeding tube must be checked before other diagnostic or therapeutic steps are undertaken.