A 50-year-old man undergoes Billroth II (gastrojejunostomy) for peptic ulcer disease. Three months later he develops episodic symptoms of sweating, palpitations, weakness, and diarrhoea occurring 1–3 hours after meals. The blood glucose at the time of symptoms is 52 mg/dL. This is best classified as:
- A Early dumping syndrome due to rapid gastric emptying and osmotic fluid shifts
- B Roux-en-Y stasis syndrome with bacterial overgrowth
- C Late dumping syndrome (reactive hypoglycaemia) due to rapid glucose absorption and excessive insulin response ✓
- D Afferent loop syndrome causing bilious vomiting
Correct answer: C. Late dumping syndrome (reactive hypoglycaemia) due to rapid glucose absorption and excessive insulin response
Explanation
Late dumping syndrome occurs 1–3 hours postprandially when rapid delivery of carbohydrates to the small intestine causes exaggerated GLP-1 and GIP release, triggering excessive insulin secretion and reactive hypoglycaemia. Symptoms (sweating, tremor, palpitations, confusion) are vasomotor/neuroglycopaenic. Early dumping (within 30 minutes) is due to hyperosmolar contents in the small bowel causing fluid shifts and autonomic symptoms without hypoglycaemia. Afferent loop syndrome presents with bilious vomiting relieved by the vomiting episode itself.
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.