Three-decade metabolic outcome of neonatal gastrectomy and early Roux-en-Y

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Endocrinology

Background:

• Limited data exists on the long-term effects of major gastric surgery in early childhood.
• Adverse consequences on growth and development are often anticipated in pediatric patients undergoing gastrectomy.
• This case study examines a patient who underwent gastrectomy with Roux-en-Y esophagojejunostomy in early childhood.

Observation:

• The patient experienced normal growth velocity, paralleling the third percentile for age throughout development.
• Nutritional status was maintained with daily multivitamins and monthly vitamin B12 injections, with no overt deficiencies noted in adulthood.
• A dual-energy X-ray absorptiometry scan at age 31 revealed significantly low bone mineral density.

Findings:

• Despite complete stomach removal and reconstruction in early life, successful linear growth was achieved.
• Abnormal bone mineral density was detected in adulthood, irrespective of normal serum calcium and vitamin D levels.
• This highlights a potential long-term complication of early-life gastrectomy.

Implications:

• Early-life gastrectomy may not impede linear growth but can have lasting effects on bone health.
• Long-term monitoring for bone density is crucial in individuals who have undergone major gastric surgery in childhood.
• Further research is needed to understand the mechanisms and management of bone density reduction after pediatric gastrectomy.