Cholecystectomy-Associated Postprandial Hypoglycemia

Hypoglycemia is a challenging clinical condition with a broad differential diagnosis, particularly in patients without diabetes. Identifying the underlying etiology is crucial, as management strategies vary significantly.

We report a case of severe postprandial hypoglycemia in a 19-year-old woman that developed shortly after an uncomplicated cholecystectomy. Extensive evaluation ruled out insulinoma, autoimmune hypoglycemia, and factitious causes.

The temporal relationship with surgery, postprandial symptom pattern, and unremarkable imaging suggested bile acid-mediated metabolic dysregulation due to altered bile enterohepatic circulation. The patient responded well to dietary modification and acarbose therapy.

This case highlights the need to consider cholecystectomy in the differential diagnosis of postprandial hypoglycemia, especially when classic etiologies are excluded.