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Dumping syndrome after Nissen fundoplication
F Veit1, R G Heine, A G Catto-Smith
1Department of Gastroenterology, Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
Dumping syndrome, a condition with significant morbidity, can occur in children post-Nissen fundoplication. Continuous enteral feeding proved effective for managing symptoms like failure to thrive and reactive hypoglycemia.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Endocrinology
Background:
- Dumping syndrome is rarely documented in pediatric populations.
- It presents diagnostic and management challenges in children.
- Nissen fundoplication is a surgical procedure to treat gastroesophageal reflux disease.
Observation:
- Two pediatric cases of dumping syndrome following Nissen fundoplication are presented.
- Symptoms included post-meal pallor, sweating, lethargy, diarrhea, and failure to thrive.
- Biochemical findings revealed postprandial hyperglycemia, hyperinsulinemia, and reactive hypoglycemia.
Findings:
- Continuous enteral feeding was the only effective treatment for the observed symptoms.
- Dumping syndrome can manifest with significant morbidity in children after this procedure.
- Close monitoring for hypoglycemia and unresponsiveness is crucial in pediatric patients.
Implications:
- The incidence of dumping syndrome post-fundoplication in children may be underestimated.
- Early recognition and tailored management, including nutritional support, are vital.
- This highlights the need for increased awareness among healthcare providers treating pediatric surgical patients.
Abstract:
Dumping syndrome is infrequently reported in children, but has significant morbidity. It may be difficult both to diagnose and manage. Two children are reported who developed dumping syndrome after Nissen fundoplication. Symptoms occurred soon after the operation and included post-prandial pallor, sweating, lethargy and diarrhoea. Failure to thrive was a prominent feature. Typical biochemical changes included hyperglycaemia shortly after meals, followed by hyperinsulinaemia and reactive hypoglycaemia. Effective treatment was only achieved with continuous enteral feeding. Children undergoing fundoplication should be closely monitored for episodes of hypoglycaemia and unresponsiveness. The incidence of dumping syndrome after fundoplication may be underestimated, particularly in children.