A 60-year-old man undergoes total gastrectomy for gastric carcinoma. Three months later he presents with diarrhoea, bloating, and weight loss after fatty meals. Which of the following is the MOST likely metabolic complication?
- A Dumping syndrome due to rapid gastric emptying
- B Steatorrhoea due to pancreatic exocrine insufficiency and loss of gastric acid stimulation ✓
- C Blind loop syndrome with bacterial overgrowth
- D Vitamin C deficiency causing malabsorption
Correct answer: B. Steatorrhoea due to pancreatic exocrine insufficiency and loss of gastric acid stimulation
Explanation
Following total gastrectomy, loss of the gastric reservoir and acid abolishes the normal stimulus for pancreatic enzyme and bile secretion, resulting in steatorrhoea and fat malabsorption. There is also a mismatch between food delivery to the small intestine and enzyme/bile availability. This pancreatic exocrine insufficiency-like syndrome is a recognised complication of total gastrectomy. Treatment includes pancreatic enzyme replacement. Dumping occurs but presents earlier and with different timing.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.