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Hypocalcaemic seizures following gastrectomy
Insights
Two infants developed hypocalcemia (low calcium) and rickets after stomach removal surgery for esophageal anomalies. Treatment with vitamin D resolved these serious complications, highlighting a rare risk of gastric surgery in infants.
Area of Science:
- Pediatric Surgery
- Pediatric Endocrinology
- Nutritional Deficiencies
Background:
- Subtotal gastrectomy is a rare surgical procedure in infants, often necessitated by congenital anomalies like tracheo-esophageal anomalies.
- Complications following major gastrointestinal surgery in neonates and infants can be severe and require specialized management.
- Nutritional deficiencies, particularly vitamin D deficiency, can arise from significant alterations in gastrointestinal anatomy and function.
Observation:
- Two infants presented with severe hypocalcemia (low blood calcium) and clinical/radiological evidence of rickets.
- Presenting symptoms included grand mal seizures, a critical sign of severe hypocalcemia.
- Both patients exhibited elevated parathyroid hormone levels, indicating a secondary response to chronic hypocalcemia.
Findings:
- The reported cases demonstrate a link between subtotal gastrectomy in infancy and the subsequent development of vitamin D deficiency-induced hypocalcemia and rickets.
- Parenteral vitamin D therapy was effective in correcting the biochemical abnormalities (hypocalcemia, elevated parathyroid hormone) and resolving the bone changes and clinical symptoms.
- This represents the first documented instance of vitamin D deficiency as a complication of gastric surgery in the infant population.
Implications:
- Subtotal gastrectomy in infants, though rare, carries a risk of significant metabolic complications, including vitamin D deficiency and hypocalcemia.
- Early recognition and aggressive management with vitamin D supplementation are crucial for patients undergoing such procedures.
- Further research into long-term nutritional monitoring and management strategies for infants following gastric surgery is warranted.
Abstract:
Two cases of hypocalcaemia following removal of the stomach due to complications of surgery for tracheo-oesophageal anomalies are reported. In both instances grand mal seizures were the presenting features with radiological and biochemical evidence of rickets. Both children had elevated blood parathyroid hormone levels. The bone changes, hypocalcemia and symptoms responded to parenteral vitamin D therapy. Sub total gastrectomy is a rare event in infancy and consequently no previous cases of vitamin D lack has been recorded as a complication of gastric surgery in this age group.